25-117 Provider Communications Posted Online and Operations Manual Updates for January 2025
Date: 02/06/25
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The tables below outline provider communications posted online and operations manual changes made in January 2025.
- 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 for January 2025.
Read the latest issue of the winter Provider Pulse newsletter
Check out the winter issue for details on how we are working to support you, your patients and your community. Topics in this issue include:
- Health Net’s Leadership in Health Equity is Recognized Again
- Health Net Gains Improved Outcomes and Collaboration Through Engagement
- Health Net Grant for UC Davis Stem Cell Program to Improve Access to CAR T-Cell Therapy
Download the current and past issues in the Provider Library. Then, select the applicable line of business > Provider Pulse Newsletter.
Communications posted online in January 2025
Date, Number and title | Type of notice | Audience | Lines of business1 | Summary |
|---|---|---|---|---|
1/6/25 25-006m, Alternate Sites of Care Optimization for Therapeutic Infusions – 1st Quarter 2025 | Contractual | Physicians PPGs
| IFP (Ambetter HMO/PPO) Employer Group | Encourage medication adherence for Commercial (HMO, POS, PPO) and Exchange members through the site of care optimization for therapeutic infusions (SCOTI) program. Learn more about coverage and products eligible for home infusion. |
1/9/25 25-024m, Medication Trend Updates and Formulary Changes – 1st Quarter 2025 | Contractual | Physicians PPGs
| IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina Medicare Advantage HMO/PPO | Find out about drug list and formulary changes and medication safety issues for the 1st quarter of 2025. Includes information about the voluntary withdrawal of Oxbryta from the market for the treatment of sickle cell disease due to safety concerns. |
1/14/25 25-045m, Self-Register Now to Access the State-Sponsored EVV System | News & Announcements | Physicians PPGs Ancillary providers CS providers | Medi-Cal (all counties) Molina
| Register and use the state sponsored electronic visit verification (EVV) system to track in-home service visits required by the Department of Health Care Services. Learn which provider types must use EVV and services excluded from EVV requirements. |
1/27/25 25-083m, Medical Policies – December 2024 | Contractual | Physicians PPGs Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina
| Review changes to medical policies for procedures and services for December 2024. Medical policies, available online at Health Net Medical Policies, offer guidelines for determining medical necessity for certain procedures, equipment and services. 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. |
1/31/25 25-001m, Assist Members Get Care Fast | Contractual | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Help members understand alternative ways they can access care outside of the emergency room or when their primary care physician (PCP) is not available. Includes easy-to-use access chart and information about telehealth and the Nurse Advice Line.
|
1/31/25 25-002m, Assist Members Get Care Fast | Contractual | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medicare Advantage HMO/PPO | Help members understand alternative ways they can access care outside of the emergency room or when their primary care physician (PCP) is not available. Includes easy-to-use access chart and information about telehealth and the Nurse Advice Line.
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1Medi-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 January 2025
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
1/1/25 | Doula Services (under Benefits) | Physicians PPGs Hospitals Ancillary |
| Added new information about doula services offered to members enrolled in Individual Family Plans (HMO, PPO) and Employer Group Plans (HMO, POS and PPO) starting 1/1/25. Information about eligibility, what’s covered, assistive services, and coordinating services are included. |
1/1/25 | Doula Services (under Benefits) | Physicians PPGs Hospitals Ancillary |
| Updated information about doula services for Medi-Cal. |
1/1/25 | Member Rights and Responsibilities | Physician PPGs Hospitals Ancilla |
| Updated to reflect information included in member Evidence of Coverage (EOC) for 2025. |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.