26-596 Provider Communications Posted Online and Operations Manual Updates for April 2026

4/1/26

26-415m (PDF), Medication Trend Updates and Drug List/Formulary Changes – 2nd Quarter 2026

Contractual

Physicians/
Practitioners

PPGs

• IFP (Ambetter HMO/PPO)
• Employer Group
  (HMO/POS, PPO)
• Medi-Cal (all counties)
• Medicare Advantage (HMO)

Discover what drug list and formulary changes and medication safety issues have been made in the 2nd quarter of 2026.

4/14/26

26-480m, Complete Initial Health Appointments for New Members

Regulatory

Physicians/
Practitioners

PPGs

Hospitals

Ancillary

• Medi-Cal (all counties)

Learn more about the requirements and importance of completing initial health appointments (IHAs) for new primary care members. This notice outlines key components, provider responsibilities and where to find further guidance.

4/17/26

26-466m, New Provider Resources for Commercial and Medicare Plans

News & Announcements

Physicians/
Practitioners

PPGs

Hospitals

Ancillary

Behavioral Health

• IFP (Ambetter HMO/PPO)
• Employer Group
  (HMO/POS, PPO)
• Medicare Advantage (HMO)

Reminder: New providers have access to online resources, training and tools to support their practice and interactions with us. You can access this information on the New Providers Onboarding Materials page, then select Commercial/Marketplace Products or Medicare Products (including D-SNP).

4/17/26

26-531m (PDF), Updates to Clinical Policies – March 2026

Contractual

Physicians/
Practitioners

PPGs

Behavioral Health

• IFP (Ambetter HMO/PPO)
• Employer Group
  (HMO/POS, PPO)
• Medi-Cal (all counties)

Review changes to medical policies for procedures and services for March 2026. Medical policies are available online. 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.

4/28/26

26-576m, Early Pregnancy Confirmation Incentive

News & Announcements

Physicians

• Medi-Cal (all counties)
• Molina

Find out how primary care physicians can earn a $75 incentive for each eligible Medi‑Cal member whose pregnancy is confirmed early. The Pregnancy Confirmation Incentive supports timely access to prenatal care.

4/7/26

Behavioral Health Contact Information

(under Contacts)

All

• HMO, PPO, Medi-Cal
  

Updated functions and descriptions/contact information for behavioral health providers.    

4/14/26

Member Primary Care Provider Change Request

(under Member Rights and Responsibilities>

All

• Medicare
  

Added reference to new form, which enables both members and providers to request a change to the member’s primary care provider. This form is intended for members to complete with their provider. The provider can then submit the form directly to the Plan.

Member Primary Care Provider Change Request

(under Forms & References)

Member Primary Care Provider (PCP) Change Request Form (PDF)

4/23/26

Mandatory Notification Requirements for PPG Downstream Hospital Terminations

(under Provider Oversight > Facility and Physician Additions, Changes and Deletions)

All

• HMO, PPO, Medi-Cal

New document added regarding required notification requirements for PPGs when a hospital terminates from their network. These changes are derived from the Department of Managed Health Care All Plan Letter
25-019, effective as of January 1, 2026.

4/27/26

Eligibility Verification Methods

(under Eligibility > Steps to Determine Eligibility)

All

• PPO, HMO

• Medicare

Revised documents to remove references to the “Save Time Navigating the Provider Portal” brochure and added details about features available to providers on both the Health Net and Availity provider portals.

Eligibility Verification

(under Eligibility > Steps to Determine Eligibility)

• Medi-Cal

Provider Responsibility for Verifying Eligibility for On-Exchange IFP Members in Delinquent Premium Grace Period

(under Eligibility)

• HMO, PPO

How to Secure Prior Authorization on the Provider Portal

(under Prior Authorization)

• HMO, PPO, Medicare, Medi-Cal

Accessing Claims on the Provider Portal

(under Claims and Provider Reimbursement)

• HMO, PPO, Medicare, Medi-Cal