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Prior Authorization

Please note, failure to obtain authorization may result in administrative claim denials. Health Net providers are contractually prohibited from holding any member financially liable for any service administratively denied by Health Net for the failure of the provider to obtain timely authorization.

Check to see if a pre-authorization is necessary by using our Medicare Pre-Auth Check tool. You can also refer to the following guides:

Standard prior authorization requests should be submitted for medical necessity review at least five (5) business days before the scheduled service delivery date or as soon as the need for service is identified.

Authorization requests may be submitted by fax, phone or secure web portal and should include all necessary clinical information. Urgent requests for prior authorization should be called in as soon as the need is identified.

Expand the links below to find out more information.