25-213 Provider Communications Posted Online February 2025 and Operations Manual Updates for January 2025
Date: 03/06/25
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 in February 2025, 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: Includes the effective date of the change, operations manual section, topic and summary of the change.
Communications posted online in February 2025
Date, Number and title | Type of notice | Audience | Lines of business1 | Summary |
|---|---|---|---|---|
2/14/25 25-189m, View Updated Medi-Cal Provider Materials Online | News & Announcements | Physicians PPGs Hospitals Ancillary providers CS providers ECM providers | Medi-Cal (all counties)
| Medi-Cal provider materials have been updated and are available on the New Provider Onboard Materials page. Access the page for the Medi-Cal Operations Guide, Save Time Navigating the Provider Portal brochure, the No-cost Interpreter Services flyer, and more. |
2/18/25 25-160m, Support Members Enrolled in ECM Prior to Release from Correctional Facilities | Regulatory | ECM providers | Medi-Cal (all counties)
| Enhanced Care Management (ECM) providers must follow the Justice Involved Initiative requirements when supporting eligible members assigned to them, prior to and immediately following release from correctional facilities. |
2/21/25 25-175m, Medical Policies – | 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 January 2025. 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. |
2/21/25 25-157m (PDF), Follow Access to Care Standards to Ensure Patients Get Timely Care | Regulatory | PPGs
| Medi-Cal (all counties) Molina | Review this update to ensure you maintain compliance with various access standards, and know when to authorize an out-of-network provider for members who require medically necessary services. |
2/27/25 25-194m (PDF), Stay Compliant By Reviewing Changes to Medical Policies for Medicare | Contractual | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Medicare Advantage (HMO/PPO) | Review changes to Medicare medical policies for procedures and services for February 2025. Medical policies, available online at Medicare Prior Authorization Medical Clinical 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 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 January 2025
The following updates were made to the Provider Operations Manual at the end of January 2025. These updates were not part of the January 2025 provider communication (25-117) based on the timing of the change. No changes were made to the Provider Operations Manual in February 2025.
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
1/30/25 | Autism Spectrum Disorders (under Benefits) | Physicians PPGs Hospitals Ancillay |
| Updated to include information about the availability of Applied Behavioral Analysis (ABA) Forms in the Provider Library. Providers may use these forms to refer and/or request ABA treatment for members. |
1/30/25 | Provider Appeals & Resolution (under Appeals, Grievances and Disputes) | Physicians PPGs Hospitals Ancillary |
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1/30/25 | Health Net Medicare Appeals and Grievances Department (under Contacts) | Physician PPGs Hospitals Ancillary |
| Updated contact information. |
Behavioral Health Provider Operations Manual changes in January 2025
The following update was made to the Behavioral Health Provider Operations Manual at the end of January 2025. This update was not part of the January 2025 provider communication (25-117) based on the timing of the change. No changes were made to the Behavioral Health Provider Operations Manual in February 2025.
Effective Date | Section | Topic | Summary |
|---|---|---|---|
1/31/25 | Section 13, State-Specific Information and Important Regulations | AB 1936 Maternal Mental Health Screening Requirements | Providers treating members enrolled Individual and Family Plans (IFPs) and Employer Group HMO, POS and PPO plans must include at least one mental health screening during pregnancy and another within the first six weeks postpartum (effective January 1, 2025). |
Provider Services
Line of business | Phone number | |
|---|---|---|
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
Medicare (Individual & Employer Group) (Wellcare By Health Net) | ||
Medicare Supplement | ||
Medi-Cal (including CS and ECM providers) | N/A | |
Behavioral Health providers | N/A |
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.