25-815 Provider Communications Posted Online and Operations Manual Updates for July 2025
Date: 08/07/25
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The tables below outline provider communications posted online and operations manual changes made in July 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.
Read the latest issue of the summer Provider Pulse newsletter
Check out the summer issue for details on how we are working to support you, your patients and your community. Topics in this issue include:
- More than $9 Million in Initiatives to Expand and Strengthen California’s Physician Workforce
- MLK Community Medical Group Adds More Providers Thanks to $3.5 Million Grant
- Dr. Pooja Mittal Talks Health Equity on Becker’s Payer Issues Podcast
- CalAIM Provider Resource Updates in Q2
Download the current and past issues in the Provider Library. Then, select the applicable line of business > Provider Pulse Newsletter.
Communications posted online in July 2025
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
|---|---|---|---|---|
7/11/25 25-679m (PDF), Medication Trend Updates and Formulary Changes – 3rd Quarter 2025 | Contractual | Physicians PPGs
| IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Find out what drug list and formulary changes were made for the 3rd quarter of 2025, as well as any medication safety issues to be aware of.
|
7/17/25 25-730m, 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 June 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. |
7/14/25 25-464m, Help Members More Easily Access Non-Specialty Mental Health Services | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties)
| To ensure members can get non-specialty mental health services, we’ve created Health Net’s Non-Specialty Mental Health Services member and provider outreach and education plan (PDF). The plan includes member self-referral, resources and training, and support for practitioners. |
7/21/25 25-699m (PDF), Keep Your Demographic Information Current with Symphony and Other Resources | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Reminder! Keep your information current to avoid removal from the provider directory. Learn how we regularly contact providers to ensure information is up to date and be sure to use our online form to update your demographic information if and when your information changes. |
7/21/25 25-700m (PDF), Keep Your Demographic Information Current with Symphony and Other Resources
| Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medicare Advantage (HMO) | Reminder! Keep your information current to avoid removal from the provider directory. Learn how we regularly contact providers to ensure information is up to date and be sure to use our online form to update your demographic information if and when your information changes. |
7/22/25 25-740m, Complete the Special Needs Plan Model of Care Training | Regulatory | Physicians Hospitals Ancillary providers | Medicare Advantage (HMO) | Remember to complete the Special Needs Plan Model of Care training by the end of this year. This training is required annually. Discover more information about the training and how to locate it online. |
7/23/25 25-723m (PDF), Coming Soon: the 2025 Provider Appointment Availability, After-Hours and Phone Surveys | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina Medicare Advantage (HMO | Get ready for the 2025 Provider Appointment Availability, After-Hours and Phone Surveys. Surveys take place July through December 2025. Learn more about the surveys and how physicians and other providers can demonstrate compliance. |
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 July 2025
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
7/1/25
| Sensitive Services – Rape and Sexual Assault
| Physician PPGs Hospitals Ancillary |
| Added document to HMO and PPO manuals, and updated existing Medi-Cal document, to define what are sensitive services for rape and sexual assault, and include what is covered related to emergency room care, follow-up medical treatment, mental health treatment and out-of-network services. Information also included on how to bill for these services. |
7/1/25
| Peer-to-Peer Review Request Line | Physician PPGs Hospitals Ancillary |
| Updated document with new contact information for the Peer-to-Peer Review Request Line. Includes information that needs to be available when calling. |
7/2/25 & 7/22/25
| Access to Care and Availability Standards | Physicians PPGs Hospitals Ancillary |
| Updated document to: 1) Include providers’ contractual obligation to participate in regulatory required surveys; 2) Add Chinese, Cambodian (Khmer) and Vietnamese as threshold languages in San Joaquin County. |
7/7/25 | Palliative Care Services | Physicians PPGs Hospitals Ancillary |
| Added email for Care Management Referral form submissions for palliative care services. |
7/8/25 | Infertility Treatment | Physicians PPGs Ancillary |
| Updated document with information about expanded services for infertility treatment. These expanded services are required for large group plans and offered to small group plans as of July 1, 2025, per Senate Bill 729. |
7/10/25 | Hospitals Adequate Supplies and Staffing | Hospitals |
| New document about hospitals' requirement to maintain adequate staff and supplies and to notify Health Net when staffing or supplies are compromised. |
7/16/25 | Monitoring Provider Exclusions | Physicians PPGs Hospitals Ancillary |
| Updated information to reflect that the Centers for Medicare & Medicaid Services Preclusion List, the Federal Employee Health Benefit Plan (FEHBP) Restricted Provider Database and the FEHBP Exclusion List can be accessed via the Health Net Delegation Oversight Interactive Tool (DOIT). |
7/24/25 | Palliative Care Providers list (under Forms) | Physicians PPGs Hospitals Ancillary | HMO, PPO, Medi-Cal, Medicare (PDF)
| Updated the contracted Palliative Care Providers List. |
7/25/25 | Participating Physician Group (PPG) Performance Management (under Provider Oversight) | Physicians PPGs Hospitals Ancillary |
| The PPG Performance Management document can now be access in the Provider Oversight section. |
Behavioral Health Provider Operations Manual changes in July 2025
Effective Date | Section | Topic | Summary |
|---|---|---|---|
7/1/25 | Multiple areas of manual updated, as applicable | Please refer to summary | Revised multiple sections of manual to include information about the Availity Essentials provider portal, and to use Availity Essentials to request prior authorization for certain services (as of July 1, 2025). |
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.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.