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MedicaidPrior AuthMedium impact

22-1063 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
Days to comply

Summary

Health Net California has updated prior authorization requirements for certain drugs and nutrition services. Medical billing teams must obtain prior authorization for specific codes that now require it, affecting hospitals, clinics, and LA-DHS Medi-Cal providers.

Action Required

Action needed
Immediately: Download the Provider Update PDF from Health Net California's provider library to identify which specific drug and nutrition codes now require prior authorization. Update billing system workflows to flag these codes for prior auth verification before claim submission. Train staff on new prior auth requirements to prevent claim denials.