Revised Prior Authorization Requirements

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. Please click here to view a complete copy of the new July 1, 2016, PAL requirements.


For a complete copy of the current PAL requirements, please log in to our website at 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 or by telephone at 1-888-802-7001. Customer Contact Center hours are Monday through Friday, 7:30 a.m. to 5:00 p.m., except federal holidays.

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Stacy Madden