OR Notice: Revised Prior Authorization Requirements for Health Net Health Plan of Oregon, Inc. Commercial Members

At Health Net Health Plan of Oregon, Inc. (Health Net), we regularly review the Prior Authorization List (PAL). As a valued employer group with Health Net, we want you to be aware of PAL changes that may affect your employees’ health care coverage.

 

Effective July 1, 2016, we have revised our commercial (EPO, POS, CommunityCare, and PPO) PAL requirements. Significant changes to the list are indicated below. A complete copy of the new July 1, 2016, PAL requirements can be viewed here. 

 

For a complete copy of the current PAL requirements, please log in to our website at www.healthnet.com. Under “My Coverage,” click on Preauthorizations > Prior Authorization List, or call 1-888-802-7001.

 

New outpatient items requiring prior authorization

  • Acthar® Gel

The following outpatient services require prior authorization when performed in the outpatient hospital setting. (If services are performed in an ambulatory surgery center (ASC), prior authorization is not required):

  • Abdominal paracentesis
  • Carpal tunnel surgery
  • Cataract surgery
  • Hernia repair
  • Liver biopsy
  • Tonsillectomy and adenectomy
  • Upper and lower gastrointestinal endoscopy
  • Urologic procedures

 

Prior authorization no longer required

  • Ceredase®

 

Additional information

Oregon (EPO, POS, CommunityCare, and PPO) subscribers will be sent this information by April 28, 2016. 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 1-888-802-7001. Customer Contact Center hours are Monday through Friday, 7:30 a.m. to 5:00p.m., except federal holidays.

 

 

Health Net Health Plan of Oregon, Inc. is a subsidiary 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.

 

OR_EMP_Blg (4/16)

 

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