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26-1170 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, Health Net California will discontinue pre-determination peer-to-peer (P2P) reviews for behavioral health authorization requests in Medi-Cal members across Fresno, Kings, and Madera counties. Post-determination P2P reviews for denied authorizations will remain available. Medical necessity criteria and authorization timeframes are unchanged.
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What to do
by Dec 15, 2026 · 4 steps
01Behavioral health providers and billing staff 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 Fresno, Kings, and Madera counties.
02Revise authorization request procedures to reflect that P2P discussions will only be available post-determination for denied claims.
03Staff should be trained to request post-determination P2P reviews only after receiving denial letters and to follow the instructions included in those letters.
04Verify current applicability with Health Net California Provider Services (844-966-0298) if serving these counties.
Original notice
26-1170 Changes to Behavioral Health Peer-to-Peer Reviews
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.