25-943 Provider Communications Posted Online and Operations Manual Updates for August 2025
Date: 09/08/25
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The tables below outline provider communications posted online and operations manual changes made in August 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 August 2025
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
|---|---|---|---|---|
8/8/25 25-804m, Help Prevent Tuberculosis. Make Screening Part of Routine Care | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Screen adult patients for tuberculosis risk factors and offer testing and treatment when appropriate. Early identification and care can help reduce the impact of tuberculosis in vulnerable communities. |
8/12/25 25-825m, Improve Patient Experience and Satisfaction: Key Resources for the Health Outcomes Survey | News & Announcements | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Medicare Advantage (HMO) | Discover what tools and tip sheets are available to enhance the patient experience and positively influence the Medicare Health Outcomes Survey (HOS), which is underway through Nov. 2025. |
8/19/25 25-743m, Avoid Returned Requests – Use New Prior Auth Form for RXs and Step-Therapy Exceptions | News & Announcements | Physicians PPGs
| IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | The Prescription Drug Prior Authorization or Step Therapy Exception Request form has been enhanced to include a cover page of line of business-specific contact information for different prior authorization types. |
8/19/25 25-823m (PDF), Improve Member Care By Making Medical Record Sharing Easy and Secure | News & Announcements | Physicians
| Medicare Advantage (HMO) | Learn more about the Plan’s medical record review program, which supports accurate federal reporting and helps improve patient care. This notice outlines the process, timelines and secure options for submitting records. |
8/29/25 25-926m (PDF), Updates to Medicare Clinical and Medical Policies – July 2025 | Contractual
| Physicians PPGs Hospitals Ancillary providers | Medicare Advantage (HMO) | Review changes to medical policies for procedures and services for July 2025. Medical policies are 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. |
8/29/25 25-923m (PDF), Medical Policies – | Physicians PPGs Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina
| ||
8/29/25 25-860m (PDF), Boost Member Satisfaction: No-Cost Access & Availability Webinars | 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 | Attend an upcoming no-cost webinar designed to improve compliance with access and availability standards, enhance member satisfaction, and support better survey outcomes. The sessions cover regulatory requirements, performance monitoring, and practical strategies for meeting appointment and communication standards. |
8/29/25 25-861m (PDF), Boost Member Satisfaction: No-Cost Access & Availability Webinars | Medicare Advantage (HMO) |
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 in August 2025
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
8/6/25
| Emergency Related Claims | Physicians PPGs Hospitals Ancillary | Added document to clarify that the Plan follows CMS coding and billing guides when DHCS guidelines are silent for emergency-related claim submissions. | |
8/6/25
| Language Assistance Program and Cultural Competency | Physicians PPGs Ancillary | Non-discrimination Notice forms and taglines were updated, per DHCS APL 25-005 – Standards for Determining Threshold Languages, Nondiscrimination Requirements. | |
8/6/25
| Access to Care and Availability Standards | Physicians PPGs Hospitals Ancillary | ||
8/7/25 | Grievances | Physicians PPGs Hospitals Ancillary | Updated links to access the member grievance form via the Ambetter IFP and Commercial Employee Group Plan sites. | |
8/19/25, | Prescription Drug Prior Authorization or Step Therapy Exception Form Pharmacy Services
| Physicians PPGs Ancillary |
Prescription Drug Prior Authorization or Step Therapy Exception Form (PDF)
| Updated the Prescription Drug Prior Authorization or Step Therapy Exception form, which is referenced under the Benefits > Injectables and Prescription Durg Program > Prior Authorization Process sections. Also updated the fax contact information for Pharmacy Services and added reference to the form for applicable lines of business. |
8/28/25 | Payment to Medi-Cal Prohibited Entities | Physicians PPGs Hospitals Ancillary | Added document about temporary federal restrictions that may impact Medi-Cal payments to certain entities, particularly nonprofits focused on reproductive health. |
Behavioral Health Provider Operations Manual changes in August 2025
Effective Date | Section | Topic | Summary |
|---|---|---|---|
8/6/25 | Section 12 | General Policies | Added information to clarify that the Plan follows CMS coding and billing guides when DHCS guidelines are silent regarding claims submission for emergency-related claim submissions. |
8/20/25 | Section 13 | Health Care Coverage: Rape and Sexual Assault | Added topic to clarify coverage information relating to rape and sexual assault for members. Includes billing information using standard diagnosis codes. |
8/28/25 | Section 12.5 | Payments to Medi-Cal Prohibited Entities | Added topic about temporary federal restrictions that may impact Medi-Cal payments to certain entities, particularly nonprofits focused on reproductive health. |
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.