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26-1058 Provider Communication Posted Online and Operations Manual Updates for August 2026
Act
by Aug 31, 2026
Effective date
Aug 31, 2026
Identified
Sep 9, 2026
Summary
Health Net California published multiple operational manual updates effective August 2026, with the most critical change being an update to 'Services Not Requiring Prior Authorization' (effective 8/31/26) that clarifies prior authorization exemptions for select hospice, behavioral health, maternal health, and preventive services. Additional updates address cognitive health assessment training removal, Medi-Cal prohibited entity payment guidelines, and member protections regarding public benefit form fees.
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What to do
by Aug 31, 2026 · 10 steps
01Billing team must access the updated 'Services Not Requiring Prior Authorization' document in the Provider Operations Manual (under Prior Authorization section) and implement changes to billing system rules and prior authorization workflows.
02Review and document which hospice, behavioral health, maternal health, and preventive services no longer require prior authorization.
03Update billing system to remove prior authorization requirements for identified services to prevent unnecessary claim delays and denials.
04Brief providers and front desk staff on services exempt from prior authorization to improve claim processing efficiency.
05Audit recent claims for these service categories to identify any unnecessary prior authorization requests that may have caused payment delays.
06Failure to implement these changes may result in unnecessary claim holds and processing delays.
07Additionally, by August 4, 2026: Providers should stop requiring cognitive health assessment training documentation per DHCS APL 26-014 alignment, though existing assessment and billing requirements remain.
08By August 11, 2026: Verify claims payment processing for Medi-Cal Prohibited Entities reflects updated guidelines following the H.R.
091 federal payment restriction end date (July 4, 2026).
10By August 21, 2026: Ensure front desk and billing staff do not charge Medi-Cal members for form completion or information requests related to public benefits eligibility, though medical record copy fees may still apply per California law.
Original notice
26-1058 Provider Communication Posted Online and Operations Manual Updates for August 2026
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
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