Health Net Prior Authorization

Coverage: California; Medi-Cal authorization rules and CalAIM ECM/Community Supports claims guidance are separately scoped. Not a universal commercial, Medicare or delegated-group rule.

Start with the reviewed Health Net resources below. Confirm the member's current plan, the payer's operating status, and the requested service before scheduling care or submitting a request.

At a glance

• The October 1, 2026 Medi-Cal authorization page applies to Health Net, CalViva Health and Community Health Plan of Imperial Valley fee-for-service members in the listed counties. Check the service list and delegated responsibility before submission.
• Emergency procedures do not require prior authorization.
• The page lists Health Net counties Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne; CalViva covers Fresno, Kings and Madera; Community Health Plan of Imperial Valley covers Imperial.
• Commercial, Medicare and delegated participating physician group rules require separate verification.

Where to verify prior authorization requirements

• Verification resource 1

How to submit prior authorization requests

• Use the service-specific online, phone or fax route and the inpatient or outpatient authorization form listed on the Medi-Cal requirements page.

• No direct topic-specific link was captured in the current research set.

Information commonly required

• Submit the applicable form with clinical records, treatment plans and test results required for the service.

Turnaround notes and caveats

• Emergency procedures do not require prior authorization.
• The page lists Health Net counties Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne; CalViva covers Fresno, Kings and Madera; Community Health Plan of Imperial Valley covers Imperial.
• Commercial, Medicare and delegated participating physician group rules require separate verification.

Provider resources

• Official provider policy or review source (official)
• Official provider policy or review source (official)
• Official provider policy or review source (official)

Sources

Update notes

Last updated: 2026-10-30.

• Reviewed official Medi-Cal requirements effective October 1, 2026, ECM/Community Supports claims procedures and EDI resources. Kept the secondary filing rule within the page’s CalAIM context. Primary filing, other products and delegated routing require contract review.