MedicaidPrior AuthHigh impact
26-742 Provider Communications Posted Online and Operations Manual Updates for May 2026
Health Net·CA·Prior Authorization
Effective date
May 12, 2026
We identified it
Jun 20, 2026
Summary
Multiple Medi-Cal policy updates for May 2026 including a critical prior authorization timeline change from 7 calendar days to 5 business days or 7 calendar days (whichever is less), new capitation payment procedures for newborns, and updated youth trauma screening requirements affecting claims reimbursement.
Action Required
Immediately: Update prior authorization request workflows to meet new timeline requirement of 5 business days or 7 calendar days (whichever is less) for Medi-Cal only members. Review newborn billing procedures to ensure claims are billed under mother's eligibility until individual Client Index Number is established (affects months of birth and following month). Verify youth trauma screening documentation for members under age 21 to ensure proper claims reimbursement starting April 1, 2026. Update billing team on new Medi-Cal member ID card acceptance requirements.