20-089 Prior Authorization Requirements
Date: 01/24/20
This information applies to Hospitals.
Additions and changes effective April 1, 2020
Health Net* is implementing the changes outlined below to the prior authorization requirements for Los Angeles County Department of Health Services (LA-DHS) hospitals and clinics.
Requirement | Comments | Adult members ages 21 and over | Pediatric members under age 21 |
Continuous glucose monitoring | Listed under DME – Adult | New benefit | Existing benefit under CCS.1 All DME requires prior authorization |
Aliqopa™, azedra®, Beovu®, Besponsa®, Folotyn®, Kanuma®, Lutathera®, Polivy™ | Listed under Outpatient Pharmaceuticals (Submitted under Medical Plan) | New requirement | |
1CCS – California Children’s Services
View authorization requirements online
Follow the steps below to find out if prior authorization is needed for any procedures, services or equipment:
1 Go to provider.healthnet.com.
2 Before logging in, select Working with Health Net > Policies for Non-Contracting Providers > Additional Resources > Services Requiring Prior Authorization.
3 After logging in, select Working with Health Net > Contractual > Services Requiring Prior Authorization.
If you have questions regarding the information contained in this update, contact the
Health Net Medi-Cal Provider Services Center at 1-800-675-6110.