Medicare AdvantagePrior AuthHigh impact
25-1000 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
Health Net·CA · OB-GYN, Vascular Surgery, Physical Therapy +4 more·Prior Authorization
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net California is updating prior authorization requirements effective December 1, 2025, removing PA requirements for many DME items, prosthetics, sleep studies, varicose vein treatments, and therapy services while maintaining PA requirements for non-emergency air transport, hysterectomies, and skin substitutes. These changes aim to reduce administrative burden and streamline approval processes.
Action Required
By December 1, 2025: Billing team must update prior authorization rules in billing system to remove PA requirements for DME accessories, mattresses, nerve stimulators, wheelchairs, prosthetics, sleep studies, varicose vein treatments, and therapy services over 12 visits. Continue requiring PA for non-emergency air transport (A0431, A0436), hysterectomies (58571), and all skin substitute codes. Update encounter forms and train staff on new PA requirements to prevent unnecessary delays and claim denials.