Revised Prior Authorization List Changes

California Brokers

Revised Prior Authorization Requirements for Health Net of California, Inc. and Health Net Life Insurance Company (Health Net) Commercial Members

At Health Net, we regularly review the Prior Authorization List (PAL). As a Health Net broker, we want you to be aware of PAL changes that may affect your clients’ health care coverage.

 

Effective January 1, 2016, we have revised our PAL requirements for commercial products (Direct Network HMO (including CommunityCare), EPO, HSP, POS, PPO, and Flex Net). Significant changes to the list are indicated below. A complete copy of the new January 1, 2016, PAL requirements is attached for your reference.

Changes to commercial products prior authorization requirements
Prior authorization is no longer required for:

  • Chiropractic and acupuncture visits – The prior authorization requirement has been removed for PPO, out of state PPO and Flex Net plans only. Prior authorization requirement remains in effect for all other commercial products.

 

New outpatient procedures, services or equipment requiring prior authorization include:

  • Selected outpatient medical benefit pharmaceuticals, including Cosentyx, Lemtrada, Mircera, Radiesse, Sculptra

 

Additional information

This notice applies only to subscribers whose authorization requirements are managed by Health Net. California commercial products subscribers have access to this information online at www.healthnet.com/member. If they have questions regarding the information, they should contact the Health Net Customer Contact Center either online at www.healthnet.com or by telephone at 1-800-522-0088. Customer Contact Center hours are Monday through Friday, 8:00 a.m. to 6:00 p.m., except holidays.

Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All other identified trademarks/service marks remain the property of their respective companies. All rights reserved.
LTR00492EW00_CA_PAL (10/15)

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Stacy Madden