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26-1172 Changes to Behavioral Health Peer-to-Peer Reviews
Act
by Dec 15, 2026
Effective date
Dec 15, 2026
Identified
Oct 10, 2026
Summary
Effective December 15, 2026, pre-determination peer-to-peer (P2P) reviews for behavioral health authorization requests will no longer be available for Medi-Cal members in 10 California counties. Post-determination P2P reviews for denied authorizations will continue. Medical necessity criteria and authorization timeframes remain unchanged.
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What to do
by Dec 15, 2026 · 3 steps
01Behavioral health providers billing team should update internal prior authorization workflows to eliminate requests for pre-determination peer-to-peer reviews with Health Net California for Medi-Cal members in Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, and Tuolumne counties.
02Providers must inform clinical staff that P2P reviews will only be available post-determination for denied requests, as instructed in denial letters.
03Verify current applicability with Health Net California Provider Services (844-966-0298) closer to the effective date, as this change is future-dated and may be subject to updates.
Original notice
26-1172 Changes to Behavioral Health Peer-to-Peer Reviews
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.