20-090 Prior Authorization Requirements

Date: 01/24/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

Additions and changes, effective April 1, 2020

Health Net* is implementing changes to the Cal MediConnect Plan (Medicare-Medicaid Plan) prior authorization (PA) requirements as outlined below.

Requirement	Comments
Continuous glucose monitoring	Listed under Durable Medical Equipment (DME)
Transplant	Removed HLA typing Added Transplants must be performed through Health Net’s designated transplantation specialty network

View authorization requirements online

Follow the steps below to find out if PA 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.

Additional information

Providers are encouraged to access Health Net’s provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact the
Health Net Provider Services Center by email at provider_services@healthnet.com within 60 days, by telephone or through the Health Net provider website as listed in the right-hand column.