25-945 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 communication, applicable audience, 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 (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 | Summary |
|---|---|---|---|
8/8/25 25-806m, Help Prevent Tuberculosis. Make Screening Part of Routine Care | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | 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. |
8/19/25 25-742m, Avoid Returned Requests – Use New Prior Auth Form for RXs and Step-Therapy Exceptions | News & Announcements | Physicians PPGs
| The Prescription Drug Prior Authorization or Step Therapy Exception Request form has been enhanced to include contact information for different prior authorization types. |
8/29/25 25-924m (PDF), Medical Policies – July 2025 | Contractual | Physicians PPGs Behavioral Health providers | Review changes to medical policies for July 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. |
8/29/25 25-859m (PDF), Boost Member Satisfaction: No-Cost Access & Availability Webinars | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | 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. |
Medi-Cal Provider Operations Manual changes in August 2025
Effective Date | Document name (and path) | Audience | Summary |
|---|---|---|---|
8/6/25
| Emergency Related Claims | Physicians PPGs Hospitals Ancillary providers | 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 providers | |
8/19/25, 8/26/25 | Prescription Drug Prior Authorization or Step Therapy Exception Form (PDF) Pharmacy Services
| Physicians PPGs Hospitals Ancillary providers | 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 providers | 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.
This information applies to Medi-Cal in Imperial County.