CommercialPrior AuthMedium impact
22-1061 Keep Up with Prior Authorization Changes to Drugs and Nutrition
Health Net·CA·Prior Authorization
Effective date
Dec 9, 2022
We identified it
Jun 20, 2026
Summary
HealthNet California has updated their prior authorization requirements for drugs and nutrition services. Medical billing teams need to verify which codes now require prior authorization and ensure they obtain approval before providing these services to avoid claim denials.
Action Required
Immediately: Billing team must download the updated Provider Update PDF from HealthNet's provider library to identify specific drug and nutrition codes requiring prior authorization. Update billing system workflows to flag these codes for prior auth verification. Front desk staff should verify authorization status before scheduling relevant appointments. Claims will be denied without proper prior authorization.