26-739 Provider Communications Posted Online and Operations Manual Updates for May 2026

5/8/26

26-582m (PDF), Your Patients Can Receive No-Cost Care Management Services from Health Net

News & Announcements

Physicians/
Practitioners

PPGs

Hospitals

Ancillary

Behavioral Health

• IFP (Ambetter HMO/PPO)

Discover care management services and support available for your patients in Individual & Family Plans. Learn how care management can benefit your patients, which patients may need these services and how to refer them for support.

5/13/26

26-608m (PDF), Dyadic Services:
Medi-Cal Whole Family Behavioral Health Support

News & Announcements

Physicians/
Practitioners

PPGs

Hospitals

Ancillary

ECM

CS

Behavioral Health

• Medi-Cal (all counties)

Learn how dyadic services help improve a child’s behavioral health by caring for the child and their parent or caregiver together. This Medi-Cal behavioral health benefit is available to children and youth under age 21 along with the parent/caregiver, and can help providers identify concerns early, strengthen family relationships, and connect families to needed support.

5/28/26

26-712m (PDF), Updates to Clinical Policies – April 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 April 2026. Medical policies are available online at Medical policies:

• Commercial, Medi-Cal
• Medicare

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.

5/28/26

26-713m (PDF), Updates to Medicare Clinical Policies – April 2026

Contractual

Physicians/
Practitioners

PPGs

Behavioral Health

• Medicare Advantage (HMO)

5/29/26

26-718m, Capitation Payments for Newborns: No Separate Payment Until Month 3

Contractual

Physicians/
Practitioners

PPGs

• Medi-Cal (all counties)

Find out how Medi-Cal capitation payments are handled for newborns during the month of birth and the following month. Includes the steps providers should take to help ensure payments are processed correctly until the newborn’s individual Client Index Number is established.

April and May 2026

Refer to Summary for a complete description of change

All

April-May 2026 Changes to the Provider Operations Manuals (PDF)

As of a result of the annual review of the Medi-Cal Provider Operations Manual, multiple documents across all line-of-business-specific provider operations manuals have been modified. Please refer to the link under "Lines of business and URL" for information on the sections, subsections, lines of business and URLs that were updated.

5/1/26

Member ID Cards

(under ID Cards)

All

• Medi-Cal

Added a sample of a newly designed Medi-Cal member ID card. Providers must accept both the new and existing ID cards.

5/12/26

Requesting Prior Authorization or Coordinating a PCP Referral

(under Prior Authorization)

Physicians/ Practitioners

PPGs

Hospitals

• Medi-Cal
    

Updated the standard prior authorization timeline for Medi-Cal only from “seven calendar days” to “the lesser of five business days or seven calendar days” to align with regulations.

Authorization and Referral Timelines

(under Provider Oversight > Service and Quality Requirements)

PPGs

• Medi-Cal

Enteral Nutrition

(under Benefits)

All

• Medi-Cal

5/15/26

Mental Health

(under Public Programs)  

All

• Medi-Cal
  

Updated youth trauma screening requirements due to regulatory changes. Changes may affect claims reimbursement for providers who screen Medi-Cal members under age 21 for Specialty Mental Health Services access or adverse childhood experiences, effective April 1, 2026.

Adverse Childhood Experiences (ACEs)

• Medi-Cal
  
• HMO, PPO
  

5/15/26

Therapeutic Injections and Other Injectable Substances

(under Benefits > Injectables)

All

• HMO, PPO, Medi-Cal
  

The Injectable Medication HCPCS/DOFR Crosswalk has been updated for the 1st quarter of 2026.

5/21/26

Health Information Form

(under Enrollment)

Physicians/ Practitioners

PPGs

• HMO, PPO, Medi-Cal
  
  

New document added about the Health Information Form. New members receive the form in the member enrollment packets and are asked to complete it within 90 days of joining the Plan. Direct links to the form (in English and other languages) is available in the operations manual for easy access and reference if members request help to complete it.

5/21/26

Facility Site Review

(under Quality Improvement)

Physicians/ Practitioners

PPGs

• Medi-Cal
  
  

Updated the following reference materials in document:

• Facility Site Review & Medical Record Review Preparation List (Northern and Southern California)
• Sample Medication Policy, Procedure and Logs
• Suicide Risk Screening Tools
• Pharmaceutical Services Policy & Procedure
• Pediatric Health Maintenance Checklist
• Adult Health Maintenance Checklist
• Notice to Consumers: Nurse Practitioners Licensure (NEW)

5/22/26

Children

(under Eligibility)

All

• Medi-Cal
  
  

Revised document to clarify that, until the newborn’s individual Client Index Number is established, Medi-Cal capitation payments for the month of birth and the following month are covered under the mother’s eligibility.

Ambetter from Health Net IFP

Ambetter PPO

844-463-8188

email

Ambetter HMO

888-926-2164

email

Health Net Employer Group HMO, POS, & PPO

800-641-7761

email

Medicare (Individual & Employer Group)

(Wellcare By Health Net)

800-929-9224

email

Medicare Supplement

800-641-7761

email

Medi-Cal (including CS and ECM providers)

800-675-6110

N/A