Overview

Selected specialty and outpatient services that cannot be provided in a primary care physician's (PCP's) or specialist's office require prior authorization as outlined on the as outlined on the Prior Authorization Requirement for Cal MediConnect Product list (PDF).

Fax the requests for prior authorization to the Health Net Medical Management Department listed on the Inpatient California Health Net Commercial Prior Authorization (PDF) or the Outpatient Calfiornia Health Net Commercial Prior Authorization (PDF).

The Health Net Medical Management Department accepts prior authorization requests for elective and urgent services by fax only.

To initiate the prior authorization process providers must:

• Verify member eligibility and benefit coverage by accessing the Health Net provider portal or by contacting the Health Net Provider Services Center
• Complete the prior authorization form, including CPT codes and sufficient clinical information to support the medical necessity of the request. Incomplete forms or forms with insufficient information at the time of submission delay processing (some surgical requests, such as requests for reconstructive surgery or repair require submission of non-returnable color photos, models or X-rays)

Providers may obtain the status of an authorization by contacting the Health Net Medical Management Department or visiting the Health Net provider website. Emergency services do not require prior authorization.