21-549 New Fax Numbers to Request Medication Prior Authorization
Date: 07/29/21
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.
Effective October 1, 2021, fax prior authorization requests for medications to the numbers listed below
Use the appropriate fax numbers when requesting prior authorization (PA) for the following:
- Pharmacy PA: For initial PA and formulary exception requests for medications that are prescribed to a member and covered under the pharmacy plan and dispensed by a network pharmacy.
- Medical pharmacy PA: For medications that are covered under a member’s medical plan and are administered by a health care professional in a provider’s office, outpatient hospital, infusion center or through a home infusion provider.
Products | Types of Request | New Fax Number |
|---|---|---|
Commercial | Pharmacy and medical pharmacy PA | 866-399-0929 |
Medicare | Pharmacy and medical pharmacy PA | 800-977-8226 |
Medi-Cal | Pharmacy PA | 866-399-0929 |
Medical pharmacy PA | 833-953-3436 |
You may continue to fax PA requests for medications with the current fax number until October 1, 2021.
Relevant sections of Health Net’s provider operations manuals will be revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library, located on Health Net’s provider website.
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 | ||
EnhancedCare PPO (SBG) | 1-844-463-8188 | provider_services@healthnet.com | |
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | provider_services@healthnet.com | |
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | provider_services@healthnet.com | |
Medicare (individual) | 1-800-929-9224 | provider_services@healthnet.com | |
Medicare (employer group) | 1-800-929-9224 | provider_services@healthnet.com | |
Medi-Cal | 1-800-675-6110 | N/A |