20-785 Use Updated Prior Authorization Forms for Easier Completion
Date: 11/13/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Auto-fill feature helps simplify completing the forms, and ensures you have included all info needed to process your request
Health Net has updated the prior authorization (PA) forms online to include both an inpatient (IP) and outpatient (OP) form for all lines of business. The forms include the same information as before with the following additions:
- An address field for providers to complete.
- Auto-fill fields and the fax number in the upper right corner for ease of use.
Start using the new, updated prior authorization forms today!
Please use the new, updated IP and OP forms to make it easier for you to complete your PA request. Plus, they help ensure Medical Management has your address and other required information to process your request. The updated forms include:
- Inpatient California Health Net Commercial Prior Authorization1
- Outpatient California Health Net Commercial Prior Authorization1
- Inpatient California Health Net Medicare Prior Authorization1
- Outpatient California Health Net Medicare Prior Authorization1
- Inpatient California Medi-Cal Prior Authorization
- Outpatient California Medi-Cal Prior Authorization
PA requests that you have submitted using PA forms other than the updated forms above will continue to be processed to ensure there is no delay in requests for authorization.
Access prior authorization forms in three ways
- Go directly to the provider website. Select Working with Health Net under Want To Work With Us, then scroll down and select Services Requiring Prior Authorization under Additional Resources.
- Go directly to the Provider Library. Select the appropriate line of business, then select Forms and References to find and download the IP or OP PA form.
- Go to the Provider Library after you have logged on to the provider website.
For a member | Go to: | Then: |
|---|---|---|
Individual MA, IFP CommunityCare, HMO, PPO, PureCare HSP, PureCare One EPO, and EnhancedCare PPO | Health Net California Provider Portal | 1. Under Welcome, select Resources > Contractual > Go to the Provider Library to select provider type. 2. Select Forms and References to access and download the IP or OP PA form. |
Employer group MA HMO, EPO, HMO, POS, HSP, PPO, EPO, and Medi-Cal
|
| 1. From the home page, scroll to the bottom and select the Provider Library tile. 2. Select line of business and go to Forms and References to access and download the IP or OP PA form. |
Additional information
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:
| Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
| EnhancedCare PPO (IFP) | 1-844-463-8188 | Health Net California Provider Portal | provider_services@healthnet.com |
| EnhancedCare PPO (SBG) | 1-844-463-8188 | Health Net Provider Portal | provider_services@healthnet.com |
| Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | Health Net Provider Portal | provider_services@healthnet.com |
| IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | Health Net California Provider Portal | provider_services@healthnet.com |
| Medicare (individual) | 1-800-929-9224 | Health Net California Provider Portal | provider_services@healthnet.com |
| Medicare (employer group) | 1-800-929-9224 | Health Net Provider Portal | provider_services@healthnet.com |
| Medi-Cal | 1-800-675-6110 | Health Net Provider Portal | N/A |
1Individual Family Plans (IFPs) and individual Medicare plans are now combined with group plans in the updated forms above.