Health Net Revised Prior Authorization List Changes

Nov 19, 2015

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

Health Net regularly reviews the Prior Authorization List (PAL) and they want you to be aware of PAL changes that may affect your clients’ health care coverage.

Effective January 1, 2016, Health Net has revised their 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 available 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.

For questions, please contact a member of your b&p Sales Team - 888.722.3373.