25-1182 Provider Communications Posted Online and Operations Manual Updates for October 2025
Date: 11/07/25
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The tables below outline provider communications posted online and operations manual changes made in October 2025.
- Communications posted online: Includes the posting date, material number and title, type of communication, applicable audience, and a summary of the communication.
- Medi-Cal 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 October 2025.
Read the latest issue of the fall Provider Pulse newsletter
Check out the fall issue for details on how we are working to support you, your patients and your community. Topics in this issue include:
- California Community Health Centers Help More Families Stay Healthy with $45,000 From Health Net
- California’s Physician Pipeline Gains Steam Through Investments
- New Fact Sheet Shares Health Needs of LGBTQ+ Kids in California
- California Medicare and Medicaid Members Get Expanded Options in 2026 Plans
Download the current and past issues in the Provider Library. Then, select the applicable line of business > Provider Pulse Newsletter.
Communications posted online in October 2025
Date posted | Number and title | Type of notice | Audience | Summary |
|---|---|---|---|---|
10/14/25 | 25-1049m, Patient Privacy Matters: Key Requirements for Providers | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Stay current on key requirements for protecting patient privacy, including maintaining HIPAA-compliant policies, safeguarding sensitive health information and ensuring confidential communications. |
10/15/25 | 25-1034m, Protect Your Patients With the Flu Vaccine: Flu Season Has Arrived | News & Announcements | Physicians PPGs
| Help reduce flu-related illness and hospital stays—find out about flu vaccine updates for 2025-2026, tips to help reassure and educate patients about the vaccine, and vaccine coverage and reimbursement. |
10/20/25 | 25-1030m (PDF), Medication Trend Updates and Formulary Changes – 4th Quarter 2025 | Contractual | Physicians PPGs
| Find out about drug list and formulary changes and medication safety issues for the 4th quarter of 2025.
|
10/29/25
| 25-1123m, Medical Policies – August 2025 | Contractual | Physicians
| Review changes to medical policies for September 2025. Medical policies, available online at 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. |
10/31/25 | 25-1120m (PDF), 2024 Provider Access Survey Results | News & Announcements | Physicians PPGs Ancillary providers Behavioral Health providers | Learn how providers performed in the 2024 Provider Appointment Availability and Provider After-Hours Access Survey. Survey results are used to monitor provider compliance with timely access and after-hours regulations and evaluate the effectiveness of the network to meet the needs of members. |
Medi-Cal Provider Operations Manual changes in October 2025
Effective Date | Document name (and path) | Audience | Summary |
|---|---|---|---|
10/20/25
| Billing and Authorization Procedures for Non-Benefit Codes (under Claims and Provider reimbursement) | Physicians PPGs Hospitals Ancillary | New document to clarify DHCS’ policy on “non-benefit” codes and how it affects claims, prior authorization and dispute processes. |
10/20/25 | Prior Authorization | Physician PPGs Hospital Ancillary | Updated to clarify the options for submitting prior authorization for injectable medications, based on line of business. |
10/30/25 | Blood Pressure Monitor Request Form (under Forms and References) | Physicians PPGs Hospital Ancillary | Updated durable medical equipment contact information; added fields for height and weight. |
10/31/25 |
(under Benefits)
| Physicians PPGs Hospitals Ancillary | Updated to clarify documentation that must be submitted within five calendar days of a hospice election. Also added reference to Hospice Services Documentation Guide (PDF), which is also available under Forms and References. |
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.
This information applies to Medi-Cal in Imperial County.