26-157 Provider Communications Posted Online and Operations Manual Updates for January 2026
Date: 02/06/26
Access the Provider Library for the latest operational and Plan updates and changes to better service your patients
The tables below outline provider communications posted online and operations manual changes made in January 2026 for Wellcare By
Health Net (Health Net) providers.
- Communications posted online: Includes the posting date, material number and title, type of notice, applicable audience, and a summary of the communication.
- Provider operations manual changes (for physicians and practitioners, 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, URL, and a summary of the change.
Communications posted online in January 2026
Date, number and title | Type of notice | Audience | Summary |
|---|---|---|---|
1/2/26 26-019m, Medication Trend Updates and Drug List/Formulary Changes – 1st Quarter 2026 | Contractual | Physicians/ PPGs | Discover changes for the formulary and any new medication safety issues to be aware of for the 1st quarter of 2026. |
1/9/26 26-005m (PDF), Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults | News & Announcements | Physicians/ PPGs Hospitals Ancillary Behavioral Health | Refer to this updated tip sheet about concurrent use of two or more anticholinergic medications in older adults. Changes include a new “Tips for success” section and a refreshed categories, medications and recommended alternatives table. |
1/23/26 26-061m, Updates to Medicare Clinical Policies - December 2025 | Contractual | Physicians/ PPGs Hospitals Ancillary Behavioral Health | Review changes to medical policies for procedures and services for December 2025. Medical policies are available online at Medical policies. 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. |
Provider operations manual changes in January 2026
Effective Date | Document name (and path) | Audience | URL | Summary |
|---|---|---|---|---|
1/1/26
| Appeals, Grievances and Disputes | Physicians/ PPGs Hospitals Ancillary | Member Appeals > Procedures and Requirements
| Updated prior authorization timeline information in these documents to seven calendar days for Medi-Cal and Medicare, per the Centers for Medicare & Medicaid Services Final Rule CMS-0057-F, effective 1/1/26. The inpatient and outpatient Medi-Cal and Medicare Prior Authorization forms were also updated and are available under the Forms and References section of the Provider Library at Forms and References.
|
PPGs | Member Appeals > Organization Determinations
| |||
Physicians/ PPGs Hospitals Ancillary | Expedited Reviews > Expedited Reviews Overview
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PPGs | Expedited Reviews > Expedited Organization Determination Criteria and Process
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Investigational and Experimental Treatment (under Referrals) | Physicians/ PPGs Hospitals
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Prior Authorization | Physicians/ PPGs Hospitals Ancillary | Prior Authorization Process for Direct Network Providers
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Physicians/ PPGs Hospitals
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Provider Oversight | PPGs | Authorization and Referral Timelines |
This information applies to Physicians, Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.