25-425 Provider Communications Posted Online and Operations Manual Updates for April 2025
Date: 05/07/25
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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 communication, applicable audience and counties, 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, path to section where document is located, URLs, audience 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:
- CalViva Health enhances city center with green space investment.
- Health Net joins UCLA Center for Health Policy Research in health equity celebration.
- At-risk Californians can seek housing through nonprofit rental deposits.
- California plan leaders unite to launch value-based payment.
Download the current and past issues in the Provider Library. Then, select Medi-Cal > Provider Pulse Newsletter.
Communications posted online in April 2025
Date, number and title | Type of notice | Audience | Medi-Cal counties | Summary |
|---|---|---|---|---|
4/14/25 25-340m, Annual Provider Satisfation Survey Coming in May 2025 | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | 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 25-373m (PDF), Medical Policies – March 2025 | Contractual | Physicians PPGs Behavioral Health providers | Fresno Kings Madera | Review changes to medical policies for procedures and services for March 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. |
4/18/25 25-339m, Revised CAHPS Survey Results for Update 25-259m Provided Here | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | Clarifies survey results for the Medi-Cal Product Level Adult Survey Outcomes for CAHPS Programs section that was originally posted in the 25-259m notice on 3/20/25. |
4/23/25 25-384m (PDF), Medication Trend Updates and Formulary Changes – 2nd Quarter 2025 | Contractual | Physicians PPGs
| Fresno Kings Madera | Informs providers of drug list and formulary changes and medication safety issues for the 2nd quarter of 2025. |
4/30/25 25-433m, Sunsetting of the Fit Families for Life Program | News & Announcements | Physicians PPGs Hospitals Ancillary providers | Fresno Kings Madera | 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. |
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in April 2025
Effective Date | Document name, path (if applicable) and URL | Audience | Summary |
|---|---|---|---|
4/1/25
|
(under Quality Improvement) | Physicians PPGs Hospitals Ancillary | 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 the manual once available. |
4/11/25 | Requesting Prior Authorization or Coordinating a PCP Referral (under Prior Authorization) | Physician Hospitals Ancillary | 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)
| Physician PPGs Hospitals Ancillary | ||
|
(under Delegated Medical Management) | PPGs Hospitals | ||
4/15/25 | (under CalAIM) | Physician PPGs Hospitals Ancillary | Added high-level overview documents and information about Enhanced Care Management, Community Supports and Community Health Worker services. |
4/21/25 | Professional and Institutional Capitated Encounter Submission Requirements (under Encounters) | Physician PPGs Hospitals Ancillary | 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 Ancillary | 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.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.