20-787 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.
Auto-fill feature helps simplify completing the forms, and ensures you have included all info needed to process your request
Health Net, on behalf of CalViva Health, has updated the online Medi-Cal prior authorization (PA) forms to include both an inpatient (IP) and outpatient (OP) form. 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, Medi-Cal 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 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 questions about the prior authorization forms, contact the Medical Management Department at 1-800-977-7282. You may also contact CalViva Health at 1-888-893-1569.