Transcription of Prior Authorization Requirements - Health Net
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Prior Authorization Requirements - Health Net
California Prior Authorization Requirements Health Net Community Solutions, Inc. ( Health Net) and CalViva Health Medi-Cal fee-for-service (FFS) members in the following counties: Kern, Los Angeles, Molina, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare Fresno, Kings and Madera (CalViva Health ) Effective: July 23, 2018 Page 1 of 9 Effective: July 23, 2018 The following services, procedures and equipment are subject to Prior Authorization Requirements (unless specified as notification required only), as indicated by X. If X is not present, Prior Authorization may not be required or the service, procedure or equipment may not be a covered benefit. When faxing a request, please attach pertinent medical records, treatment plans, test results, and evidence of conservative treatment to support the medical appropriateness of the request.
California Medi-Cal FFS providers in Los Angeles, Sacramento, San Diego, San Joaquin, Stanislaus, and Tulare counties; and Fresno, Kings and Madera counties
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