25-325sum Summary Update: Updates to the Prior Authorization Process, and New and Upcoming Requirements Changes
Date: 04/11/25
Stay aligned with available options for submitting prior authorization requests; discover what’s changed or will change for procedures, services and drugs
Refer to the complete update, 25-325, Updates to the Prior Authorization Process, and New and Upcoming Requirements Changes (PDF), for the prior authorization updates detailed below.
Use any of three options for submitting prior authorization requests
Physicians and other providers can submit requests for prior authorization via any of the following:
- Fax – Complete the appropriate Community Health Plan of Imperial Valley Inpatient or Outpatient Prior Authorization Request form, and fax to 800-743-1655. Forms are available at Prior Authorizations.
- Online – Log on to the secure provider portal.
- Phone – Call Provider Services at 833-236-4141. Behavioral health providers may contact
844-966-0298.
Key prior authorization requirements changes include:
- New CPT and HCPCS codes issued by the Centers for Medicare & Medicaid Services (CMS) that require prior authorization as of January 1, 2025.
- Additions, effective immediately, on April 1 or on June 15, 2025.
- Additional procedures, services (including durable medical equipment and outpatient pharmaceuticals) that require prior authorization as of April 1, 2025, per new CPT and HCPCS codes issues by CMS, will be communicated in a forthcoming provider update.
- Changes, effective immediately.
- Removals, effective June 15, 2025.
How to access prior authorization requirements
Use either option below to access the Medi-Cal Prior Authorization Requirements:
- Go to the Provider Library, select Medi-Cal, then select Prior Authorization Requirements on the left side.
- Go to Prior Authorizations and select the Imperial County – Community Health Plan of Imperial Valley (CHPIV) Prior Authorization List.
Additional information
If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141. Behavioral Health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.
This information applies to Medi-Cal in Imperial county.