25-818 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 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: 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:
- Building Stronger Communities Together: CalViva Health Supports Habitat for Humanity in Firebaugh
- CalViva Health Honored for Leadership in Health Equity Across Central California
- 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
Download the current and past issues in the Provider Library. Then, select Medi-Cal > Provider Pulse Newsletter.
Communications posted online in July 2025
Date, number and title | Type of notice | Audience | Medi-Cal counties | Summary |
|---|---|---|---|---|
7/3/25 25-690m, Accessing Therapeutic Infant Formula With Prior Authorization | Contractual | Physicians PPGs Hospitals Ancillary providers | Fresno Kings Madera | Clarifies information about therapeutic infant formula – how to request prior authorization, where members can access it and special considerations. It also informs how the emergency two-week supply works. |
7/11/25 25-680m (PDF), Medication Trend Updates and Formulary Changes – 3rd Quarter 2025 | Contractual | Physicians PPGs
| Fresno Kings Madera | 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. |
7/14/25 25-465m, Help Members More Easily Access Non-Specialty Mental Health Services | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | To ensure members can get non-specialty mental health services, we’ve created CalViva Health’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. |
7/17/25 25-732m, Medical Policies – | Contractual | Physicians PPGs Behavioral Health providers | Fresno Kings Madera | Review changes to medical policies for June 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. |
7/21/25 25-697m (PDF), Keep Your Demographic Information Current with Symphony and Other Resources | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | 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.
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7/23/25 25-724m (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 | Fresno Kings Madera | 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. |
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in July 2025
Effective Date | Document name, path (if applicable) and URL | Audience | Summary |
|---|---|---|---|
7/1/25
| Sensitive Services – Rape and Sexual Assault
| Physicians PPGs Hospitals Ancillary | Updated 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 (under Contacts) | 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
| Access to Care and Availability Standards | Physicians PPGs Hospitals Ancillary | Updated document to include providers’ contractual obligation to participate in regulatory required surveys. |
7/10/25 | Hospitals Adequate Supplies and Staffing (under Provider Oversight > Facility and Physician Additions, Changes and Deletions) | Hospitals
| New document about hospitals’ requirement to maintain adequate staff and supplies and to notify Health Net when staffing or supplies are compromised. |
7/10/25 | 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 Delegation Oversight Interactive Tool (DOIT). |
7/24/25 | Palliative Care Providers list (PDF) (under Forms) | Physicians PPGs Hospitals Ancillary | 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 accessed 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.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.