20-440 New Prior Authorization Requirements
Date: 06/08/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
Request prior authorizations for medications listed in this update
Please review the medications in this update to find out when you need to request prior authorization (PA) for Medi-Cal fee-for-service (FFS) members.
Medications requiring PA immediately
The below medications require PA immediately per new injectable medication HCPCS codes issued by the Centers for Medicare & Medicaid Services (CMS) on April 1, 2020:
- Adakveo®
- Givlaari®
New PA requirements starting August 11, 2020
You will need to request PA for the medications listed below:
Blincyto® | Ozurdex® | Synribo® | Vyondys 53® |
Erbitux® | Panhematin® | Triptodur® | Yutiq™ |
Faslodex® | Retisert® | Vectibix® | Zaltrap® |
Mozobil® | Revcovi™ | Vidaza® |
|
The above medications are listed in the PA list under Outpatient Pharmaceuticals (Submitted under Medical Plan).
View PA 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 the 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 CalViva Health at 1-888-893-1569.