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25-422 Provider Communications Posted Online and Operations Manual Updates for April 2025

Date: 05/07/25

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 and operations manual changes made in April 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 April 2025.

Read the latest issue of the spring Provider Pulse newsletter

Check out the spring issue for details on how we are working to support you, your patients and your community. Topics in this issue include:

Health Net joins UCLA Center for Health Policy Research in health equity celebration.
L.A. area residents get support and supplies as part of Health Net’s wildfire response.
L.A. community boards add expertise and experience from Health Net.
California plan leaders unite to launch value-based payment.

Download the current and past issues in the Provider Library. Then, select the applicable line of business > Provider Pulse Newsletter.

Communications posted online in April 2025

Date, number and title	Type of notice	Audience	Lines of business¹	Summary
4/7/25 25-292m, Dual Special Needs Plan (D-SNP) Webinars, FAQs and More Resources Online for 2025	News & Announcements	Physicians PPGs Hospitals Ancillary providers	Medicare Advantage (HMO)	Reminder about the D-SNP Resources for Providers webpage where you can find information on D-SNP webinars, FAQs and more.
4/14/25 25-350m, Monitor and Guide Members Who are Taking Antidepressant Medication	News & Announcements	Physicians PPGs Behavioral Health providers	IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO)	Find out how you can help members adhere to antidepressant medication and have open conversations about potential side effects.
4/14/25 25-342m, Annual Provider Satisfation Survey Coming in May 2025	News & Announcements	Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers	IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina	Heads Up! You may be randomly selected to participate in the upcoming Annual Satisfaction Survey. If you’re contacted, please take a few minutes to let us know about your experience so we can improve in the future.
4/14/25 25-343m, Annual Provider Satisfation Survey Coming in May 2025	News & Announcements	Physicians PPGs Hospitals Ancillary providers Behavioral Health providers	Medicare Advantage (HMO)	Heads Up! You may be randomly selected to participate in the upcoming Annual Satisfaction Survey. If you’re contacted, please take a few minutes to let us know about your experience so we can improve in the future.
4/23/25 25-371m (PDF), Medical Policies – March 2025	Contractual	Physicians PPGs Behavioral Health providers	IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina	Review changes to Commercial and Medi-Cal policies for March 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.
4/23/25 25-383m (PDF), Medication Trend Updates and Formulary Changes – 2nd Quarter 2025	Contractual	Physicians PPGs	IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina Medicare Advantage (HMO)	Informs providers of drug list and formulary changes and medication safety issues for the 2nd quarter of 2025.
4/24/25 25-398m (PDF), Concurrent Use of Opioids and Benzodiazepines	News & Announcements	Physicians PPGs Hospitals Ancillary providers Behavioral Health providers	Medicare Advantage (HMO)	Refer to these new Star Measure tip sheets as a resource for Medicare members you care for! Learn about the adverse effects of patients concurrently using opioids and benzodiazepines. This tip sheet includes information about the COB measure, descriptions and a table with examples of both types of medications. Also, find out about the concurrent use of two or more anticholinergic medications in older adults for 30 or more days. This tip sheet includes information about the POLY-ACH measure, descriptions and a table listing therapeutic categories and related anticholinergic medications.
4/24/25 25-396m (PDF), Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults	News & Announcements	Physicians PPGs Hospitals Ancillary providers Behavioral Health providers	Medicare Advantage (HMO)
4/30/25 25-432m, Sunsetting of the Fit Families for Life Program	News & Announcements	Physicians PPGs Hospitals Ancillary providers	Medi-Cal (all counties)	The Fit Families for Life Program and the Healthy Habits for Healthy People self-paced intervention resource guide are no longer available. Other weight management resources can be requested for members using the online printed materials request form.

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 April 2025

Effective Date	*Document name (and path)*	Audience	Lines of business and URL	Summary
4/1/25	Facility Site Review (under Quality Improvement)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Temporarily removed Non-Physician Medical Practitioners policy and procedure (P&P) due to changes to the number of nurse practitioners that can be assigned to providers. P&P currently being updated and will be added back into manual once available.
4/11/25	Care Management Referral Form (under Forms and References)	Physician PPGs Hospitals Ancillary	HMO, PPO, Medicare, Medi-Cal	Updated form to include palliative care referral contact and behavioral health reference information.
4/11/25	Prior Authorization Process for Direct Network (under Prior Authorization)	Physician PPGs Hospitals Ancillary	HMO, Medicare	Updated information in documents to clarify prior authorization process and the contact information for providers to use to submit prior authorization request via phone, fax or online.
Health Net – Prior Authorization (under Contacts)	HMO, PPO, Medicare, Medi-Cal
Prior Authorization Process (under Prior Authorization)	Physician Hospital Ancillary	PPO
Requesting Prior Authorization or Coordinating a PCP Referral (under Prior Authorization)	Medi-Cal
PPGs’ Responsibilities and Authorization (under Prior Authorization)	PPGs	HMO, Medicare
Authorization and Referral Timelines (under Provider Oversight > Service and Quality Requirements)	PPGs Hospitals	HMO, PPO, Medicare
Overview (under Delegated Medical Management)	HMO, Medi-Cal
Bariatric Surgery (under Benefits)	HMO, PPO
4/15/25	Enhanced Care Management (ECM) Community Supports Community Health Workers Services (under CalAIM)	Physician PPGs Hospitals Ancillary	Medi-Cal ECM CS CHW:	Added high-level overview documents and information about Enhanced Care Management, Community Supports and Community Health Worker services.
4/18/25	Doula Services (under Benefits)	Physician PPGs Hospitals Ancillary	HMO, PPO	Updated Doula Services information to include program availability for HMO and PPO members. Includes information on doula programs, requirements and more.
4/21/25	Professional and Institutional Capitated Encounter Submission Requirements (under Encounters)	Physician PPGs Hospitals Ancillary	Medi-Cal, Medicare, HMO Medicare: HMO	Minor edits applied and updated Professional & Institutional Standards for Trading Partners reference document.
4/21/25	Transplant Performance Centers (under Benefits > Transplants)	Physician PPGs Hospitals	HMO, Medi-Cal, Medicare	Updated the Transplant Performance Center List that’s linked to from the transplant information section under Benefits. The list is also available in the Forms and References section in the Provider Library.

Effective Date

Document name (and path)

Audience

Lines of business and URL

Summary

4/1/25

Facility Site Review

(under Quality Improvement)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Temporarily removed Non-Physician Medical Practitioners policy and procedure (P&P) due to changes to the number of nurse practitioners that can be assigned to providers. P&P currently being updated and will be added back into manual once available.

4/11/25

Care Management Referral Form

(under Forms and References)

Physician

PPGs

Hospitals

Ancillary

HMO, PPO, Medicare, Medi-Cal

Updated form to include palliative care referral contact and behavioral health reference information.

4/11/25

Prior Authorization Process for Direct Network

(under Prior Authorization)

Physician

PPGs

Hospitals

Ancillary

HMO, Medicare

Updated information in documents to clarify prior authorization process and the contact information for providers to use to submit prior authorization request via phone, fax or online.

Health Net – Prior Authorization

(under Contacts)

HMO, PPO, Medicare, Medi-Cal

Prior Authorization Process

(under Prior Authorization)

Physician

Hospital

Ancillary

PPO

Requesting Prior Authorization or Coordinating a PCP Referral

(under Prior Authorization)

Medi-Cal

PPGs’ Responsibilities and Authorization

(under Prior Authorization)

PPGs

HMO, Medicare

Authorization and Referral Timelines

(under Provider Oversight > Service and Quality Requirements)

PPGs

Hospitals

HMO, PPO, Medicare

Overview

(under Delegated Medical Management)

HMO, Medi-Cal

Bariatric Surgery

(under Benefits)

HMO, PPO

4/15/25

Enhanced Care Management (ECM)
Community Supports
Community Health Workers Services

(under CalAIM)

Physician

PPGs

Hospitals

Ancillary

Medi-Cal

ECM

CHW:

Added high-level overview documents and information about Enhanced Care Management, Community Supports and Community Health Worker services.

4/18/25

Doula Services

(under Benefits)

Physician

PPGs

Hospitals

Ancillary

HMO, PPO

Updated Doula Services information to include program availability for HMO and PPO members. Includes information on doula programs, requirements and more.

4/21/25

Professional and Institutional Capitated Encounter Submission Requirements

(under Encounters)

Physician

PPGs

Hospitals

Ancillary

Medi-Cal, Medicare, HMO

Medicare:

HMO

Minor edits applied and updated Professional & Institutional Standards for Trading Partners reference document.

4/21/25

Transplant Performance Centers

(under Benefits > Transplants)

Physician

PPGs

Hospitals

HMO, Medi-Cal, Medicare

Updated the Transplant Performance Center List that’s linked to from the transplant information section under Benefits. The list is also available in the Forms and References section in the Provider Library.

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.

Last Updated: 05/06/2025

25-422 Provider Communications Posted Online and Operations Manual Updates for April 2025

Access the Provider Library for the latest operational and Plan updates and changes to better service your patients

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.

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.