22-110m Clinical Trials that Require Prior Authorization

Date: 01/28/22

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.

How to get urgent status for routine care cost items and services with an approved clinical trial

A prior authorization request may be needed for routine care costs for certain items and services that are furnished as part of a qualifying clinical trial. All such requests are processed within 72 hours after the necessary clinical information is received.

Use the information below to ensure that the routine care costs that require prior authorization are processed within the urgent timeframe.

Submit the California State Attestation Form

The Attestation Form from the state will be published soon. Once it is published, please submit the form with any routine care costs associated with the clinical trial via fax to 800-743-1655. This is only for those items and services that require a prior authorization.

Interim process

Until the state Attestation Form is published, please make sure you indicate ‘Routine Care Cost Services Associated with the Clinical Trial’ to receive ‘Urgent status.’

Additional information

Providers are encouraged to access the provider portal 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 888-893-1569.