MedicaidPrior AuthHigh impact
20-220 Medical Policies - 4th Quarter 2019
Health Net·CA · Cardiology, Neurology, Gastroenterology +10 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated 25 medical policies for Q4 2019, affecting prior authorization requirements, billing codes, and coverage criteria across multiple specialties. Key changes include new prior auth requirements for antithrombin III, hypoglossal nerve stimulation, and video EEG, plus updated criteria for bariatric surgery, cardiac risk assessment, and various pain management procedures.
Action Required
Immediately: Review all 25 updated medical policies at provider.healthnet.com under Clinical > Medical Policies. Update prior authorization workflows for antithrombin III, hypoglossal nerve stimulation, and video EEG procedures. Verify bariatric surgery criteria changes (HbA1C now <7% vs previous 6.5-7%). Update billing system to reflect new CPT codes and coverage changes for pain management, genetic testing, and gender affirming procedures. Train staff on updated medical necessity criteria to prevent claim denials.