24-924 Provider Communications Posted Online and Operations Manual Updates for August 2024
Date: 09/06/24
Access the Provider Library for the latest operational and Plan updates and changes to better service your patients
The tables below outline provider communications posted online and operations manual changes made in August 2024.
- Communications posted online: Includes the posting date, material number and title, type of notice, applicable audience and lines of business, and a summary of the communication.
- Provider operations manual changes (for physicians, participating physician groups (PPGs), hospitals, and ancillary providers): Includes the effective date of the change, document name (and path to section where document is located), audience, affected lines of business and URLs, and a summary of the change.
- Behavioral Health Provider Operations Manual: No changes were made to this manual in August 2024.
Communications posted online in August 2024
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
8/5/24 24-628m, Extended-Days Supply Prescription | News & Announcements | Physicians PPGs
| Medicare Advantage HMO/PPO | Extended-Days prescriptions make it simpler and more convenient for Medicare members to adhere to taking their medications. Learn more about the benefits of Extended-Days prescriptions and find easy instructions for e-prescribing member prescriptions to Express Scripts®. |
8/20/24 24-882m, Medical Policies – July 2024 | Contractual | Physicians PPGs Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina |
Notice about changes to medical policies for procedures and services, effective July 2024 for IFP (Ambetter HMO/PPO), Employer Group (HMO/POS, PPO) and Medi-Cal (all counties, including Molina), and Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed online at Health Net Medical Policies. As a reminder, 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. |
8/30/24 24-933m, Stay Compliant By Reviewing the Changes to Medical Policies for Medicare | Contractual | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers
| Medicare Advantage HMO/PPO |
1 Medi-Cal (all counties) indicates that the communication applies to Medi-Cal Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.
Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in August 2024
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
8/1/24 | Routine Care Costs for Qualifying Clinical Trials (under Benefits > Clinical Trials) | Physicians PPGs Hospitals Ancillary |
| Added information regarding prior authorization requests submitted for routine care costs for items and services that are furnished as part of a qualifying clinical trial. These requests are considered urgent and this section includes instructions on how to obtain urgent status when submitting a prior authorization request for the routine care costs. |
8/5/24 | Palliative Care Providers (under Forms and References) | Physicians PPGs Hospitals Ancillary | HMO, PPO, Medi-Cal (PDF) | The Contracted Palliative Care Providers list was updated. The list can be accessed under Forms and References, and under Utilization Management > Care Management > Palliative Care Services in the manual. |
8/7/24 | Contacts | Physicians PPGs Hospitals Ancillary | Health Net Enrollment Services Health Net Facility Site Review Compliance Department | Updates applied to these Contacts documents. |
8/19/24 | PCP-PPG Change form – Spanish (under Forms and References) | Physicians PPGs Hospitals Ancillary |
| Spanish version of Request form PCP-PPG Change form updated. The form can be accessed under Forms and References and under Member Rights and Responsibilities > PCP Selection and Assignment in the manual. |
8/29/24 | Bariatric Surgery (under Benefits) | Physicians PPGs Hospitals |
| Updated document to include link to Health Net Bariatric Surgery Performance Centers list. |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.