25-741m Avoid Returned Requests - Use New Prior Auth Form for RXs and Step-Therapy Exceptions

Date: 08/19/25

There is new contact information for submitting prior authorization requests

A new version of the Prescription Drug Prior Authorization or Step Therapy Exception Request form (No. 61-211) is now available for use on the Health Net provider library under "Forms and References."

Please note that requests made with incorrect forms will be returned to the provider or facility for resubmission. When submitting a form for CalViva Health members, please note the contact information differs based on the line of business for which the prior authorization request is being made.

Prior authorization contact information:

Prior authorization type	Contact	Fax	Phone
Self-administered medication requests	Medi-Cal Rx	800-869-4325	800-977-2273
Physician-administered medications	Pharmacy services	833-953-3436	800-867-6564  Option 2

 

Additional information

Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on the provider portal.

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.

 

This information applies to Physicians and Participating Physician Groups (PPGs).

This information applies to Medi-Cal in Fresno, Kings and Madera counties.