25-667 Provider Communications Posted Online and Operations Manual Updates for June 2025
Date: 07/07/25
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The tables below outline provider communications posted online and operations manual changes made in June 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 June 2025
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
|---|---|---|---|---|
6/9/25 25-564m (PDF), Maximize Your Access and Availability: Join Our No-cost Webinars! | Regulatory | Physicians PPGs Ancillary providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Attend one of our 2025 webinars for insight into ways to improve member satisfaction and survey outcomes for access and availability. Find dates, times and a link to register, as well as a list of required access standards for different appointment types, the office phone and in-office wait times. |
6/9/25 25-565m (PDF), Maximize Your Access and Availability: Join Our No-cost Webinars! | Regulatory | Physicians PPGs Ancillary providers Behavioral Health providers | Medicare Advantage (HMO) | Attend one of our 2025 webinars for insight into ways to improve member satisfaction and survey outcomes for access and availability. Find dates, times and a link to register, as well as a list of required access standards for different appointment types, the office phone and in-office wait times. |
6/13/25 25-297m, Dyadic Care Services Approved for Reimbursement at Medi-Cal Fee-for-Service (FFS) Rates | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties) Molina | On Jan. 6, 2025, the Centers for Medicare & Medicaid Services (CMS) authorized the use of an alternative payment methodology to pay Federally Qualified Health Centers, Rural Health Clinics and Tribal Health Programs at the Medi-Cal fee-for-service rate for dyadic services. |
6/18/25 25-592m, 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 May 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. |
6/20/25 25-589m, Accurate Diagnosis Code Placement for Prescriptions Related to Rape and Sexual Assault | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Clarifies billing guidelines for July 1, 2025, coverage changes due to Assembly Bill 2843. Includes requirements for the correct placement of ICD-10 codes on paper and electronic prescriptions. |
6/26/25 25-626m (PDF), Community Supports Authorization Guides and Referral Forms Are Updated to Align With the DHCS | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties) Molina
| Updates have been made to select CS authorization guides and referral forms, effective July 1, 2025. This includes new program overviews, eligibility criteria, required documentation, authorization criteria, allowable providers and more. |
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 June 2025
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
6/12/25
| X-ray and Laboratory Services | Physician PPGs | Removed document that incorrectly identified diagnostic procedures that require prior authorization from Evolent (formerly NIA). | |
6/12/25 | Maternal Mental Health Screening Requirement | Physicians PPGs Hospitals Ancillary | Added reference to Notification of Pregnancy forms, which can be completed to refer members to pregnancy services and resources. These forms are also available under the Forms and References section. | |
6/12/25
| Start Smart for your Baby Care
| Physician PPGs | Updated document and added reference to the Notification of Pregnancy form, which can be completed to refer members to the Start Smart for Your Baby Care Management pregnancy program. The form is also available under the Forms and References section. | |
6/16/25
| Health Net Injectable Medication HCPCS/DOFR Crosswalk (PDF) | Physicians PPGs Hospitals Ancillary | Updated the Injectable Medication HCPCS/DOFR Crosswalk for the 1st quarter of 2025. | |
6/23/25 | Provider Marketing Guidelines (under Compliance and Regulations) | Physicians PPGs Hospitals Ancillary | Updated Provider Marketing Guidelines flyers with a revised term, “Notice of Availability” (replacing “Notice of Language Assistance”). The flyers are also available under the Forms and References section. | |
6/23/25 | Inpatient and Outpatient Prior Authorization Forms
| Physicians PPGs Hospitals Ancillary |
Commercial Inpatient Prior Authorization Form (PDF) Commercial Outpatient Prior Authorization Form (PDF)
| The Commercial (HMO/POS, PPO) and Medicare Inpatient and Outpatient Prior Authorization forms have been updated to include options for behavioral health and instructions on where to fax behavioral health requests. |
Behavioral Health Provider Operations Manual changes in June 2025
Effective Date | Section | Topic | Summary |
|---|---|---|---|
6/20/25 | Section 3 | Confidentiality Standards | Added reference to Medi-Cal Provider Marketing Guidelines with links to flyers that you can download for guidance on creating marketing materials, presentations and displays that mention Health Net and its plans or products. |
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.