25-534 Provider Communications Posted Online and Operations Manual Updates for May 2025
Date: 06/06/25
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 and operations manual changes made in May 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 May 2025
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
|---|---|---|---|---|
5/1/25 25-376m, Health Net Prefers Biosimilar Medications – 2nd Quarter | News & Announcements | Physicians PPGs
| IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Stay informed about the use of preferred biosimilar medications. This notice includes a list of brand medications and their preferred biosimilars for easy reference. |
5/9/25 25-450m, Important: Telehealth Benefits Continue Under Our Medicare Advantage (MA) Plans | News & Announcements | Physicians PPGs
| Medicare Advantage (HMO) | Clarifies the difference between Medicare Advantage plan telehealth services and the COVID telehealth waiver, which has been extended through |
5/9/25 25-410m (PDF), Extended-Day Supply Prescription | News & Announcements | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Medicare Advantage (HMO) | New tip sheet about the benefits to members when they are prescribed extended-day (100 days) supplies of prescriptions through a preferred vendor, such as Express Scripts®. |
5/16/25 25-469m, 2025 Non-formulary Drug Alternatives Are Available for Physicians and Other Providers | News & Announcements | Physicians PPGs Hospitals Ancillary providers | Medicare Advantage (HMO) | Access the updated online 2025 Guide to Covered Drug Alternatives flyer for nonformulary drug alternatives. This resource can help you identify other medications for members whose prescriptions may not be covered under their current formulary. |
5/21/25 25-471m, Medical Policies – | Contractual | Physicians PPGs Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina
| Review changes to Commercial and Medi-Cal policies for April 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. |
5/23/25 25-476m (PDF), Learn Which Anesthesia and Facility Fees are PPG Responsibility for Dental Procedures | Contractual | PPGs | Medi-Cal (all counties) Molina
| Reminder about reimbursing medically necessary services administered in connection with dental services for anesthesia and facility fees. Links are provided to a previous communication with more details and to other resources available through the Department of Health Care Services (DHCS) and in the Provider Library. Includes quick reference charts from DHCS’ All Plan Letter 23-028 on who processes which fees (anesthesia and facility). |
5/23/25 25-513m, Transforming Mental Health Access for California's Children and Youth | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties) Molina
| No-cost online behavioral health service tools and resources to help you support California’s Children and Youth Behavioral Health Initiative.
|
5/28/25 25-369m (PDF), Quick Reference Guide – Prescribing Diabetes Drugs | News & Announcements | Physicians PPGs
| Medicare Advantage (HMO) | This guide details how to look up member prescription benefits and avoid the need for re-prescribing less costly alternative medications. Includes information and direct access to the Real-Time Prescription Benefit Tool. |
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 May 2025
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
5/2/25
| Obesity | Physicians PPGs Hospitals Ancillary
|
| Updated to remove reference to the Fit Families for Life Program, which is no longer available. |
5/14/25
| Start Smart for your Baby Care | Physician PPGs |
| Added link to Notification of Pregnancy form, which can be completed when referring members to the Start Smart for Your Baby Care Management pregnancy program. |
5/19/25
| Service Providers (under Benefits > Durable Medical Equipment) | Physician PPGs Ancillary
| Medi-Cal Blood Pressure Monitor Request Form (PDF) | Updated and added information for ordering blood pressure monitors or cuffs for Medi-Cal members with the preferred durable medical equipment provider, Western Drugs. |
Western Drugs (under Contacts) | ||||
Blood Pressure Monitor Request Form (under Forms & References) | ||||
5/23/25 | Transplant Performance Centers (under Benefits > Transplants) | Physician PPGs Hospitals
|
| 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. |
Behavioral Health Provider Operations Manual changes in May 2025
Effective Date | Section | Topic | Summary |
|---|---|---|---|
5/1/25 | Section 13.1 | AB936 Maternal Mental Health Screening Requirement | Updated AB 1936 section to include reference to members enrolled in Medi-Cal plans (previously, Individual & Family Plan (IFP) and Employer Group plans were referenced only). Also added information that, “Additional screenings must be offered if determined to be medically necessary and clinically appropriate.” |
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.