23-1028 Go Online to Find Updates to Medical Policies

Date: 09/08/23

Starting in September, new and updated medical policies will be available each month and online for quick access

As of September 2023, Health Net, on behalf of CalViva Health, will notify physicians and other providers of new and updated medical policies each month instead of quarterly. You can access the monthly communication online in the Provider Library > Medi-Cal > Updates and Letters.

As a reminder, medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed at Health Net Medical Policies. All services must be medically necessary and member benefits, legal and regulatory mandates take precedence over content of medical policies and must be applied first.

Look for the monthly provider update to find the latest medical policies communication

The medical policies communication will be included in the monthly provider update that we fax, mail or email each month.

Our monthly provider update notifies you of communications that have been posted in the Provider Library in the preceding month. It includes instructions for accessing the Provider Library, and a table of communications available online, including their:

• Posting date.
• Material number and title.
• Type of notice (Contractual, Regulatory, Legislative, News & Announcements).
• Applicable audience and Medi-Cal counties.
• Summary of the notice.

What’s the upside to this change?

• More immediate notification of new and updated policies. Changing from a quarterly to a monthly notice will help provide prompt guidance to help you determine medical necessity for procedures and services.
• Helps cut down on volume of provider communications you receive. Posting the medical policies communication online each month helps reduce the volume of provider communications you receive from us by fax, mail or email.

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.

 

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.