CurrentCentenePolicy N/A

Inpatient prior authorization request form and process

Governance of inpatient prior authorization submission requirements and timelines for Health Net commercial members in California; affects requesting and servicing providers submitting authorization requests.

Policy Summary

PayerCentene

PolicyInpatient prior authorization request form and process

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit complete inpatient prior authorization requests via fax to the listed numbers and include all required supporting clinical information and required form fields.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5 business daysDetermination timeframe

72 hoursUrgent response window

844-694-9165Fax (general)

855-663-2244Fax (behavioral)

All required fieldsForm completeness

Coverage and Administrative Criteria

Administrative criteria

Administrative coverage stance and required submission elements for authorization determination.

ALL of the following

All required fields on the inpatient authorization form must be completed; incomplete forms will be rejected.
Copies of all supporting clinical information must be included; lack of clinical information may result in delayed determination.
An authorization determination is not a guarantee of payment; member eligibility, benefit coverage, and medical necessity at the time services are rendered affect payment.
Required form fields

Policy Summary

PayerCentene

PolicyInpatient prior authorization request form and process

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit complete inpatient prior authorization requests via fax to the listed numbers and include all required supporting clinical information and required form fields.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Billing and Diagnosis Codes; Required Fields

Required billing and diagnosis codesmixedCovered

CPT/HCPCS	Primary and additional procedure codes (including modifiers) are required on the form
ICD-10	Diagnosis code(s) required

Required fields completion

RequirementAll required fields must be filled; incomplete forms will be rejected.

Supporting clinical informationCopies of all supporting clinical information are required; lack of clinical information may delay determination.

Form fields referencedPrimary and additional procedure codes (CPT/HCPCS), diagnosis codes (ICD-10), admission/start date, discharge date or length-of-stay justification.

Submission, Form Requirements, and Authorization Guidance

Prior Authorization

Submission and urgency rules

Submit complete inpatient prior authorization requests via fax to the listed numbers. Include copies of all supporting clinical information. Incomplete forms will be rejected and lack of clinical information may delay determination.

Complete and Fax: 844-694-9165
Behavioral Health Requests Fax: 855-663-2244
Determination within 5 business days of receiving all necessary information

Documentation Required

Required form fields

Include all required authorization form fields. ALL REQUIRED FIELDS MUST BE FILLED IN — incomplete forms will be rejected.

Primary Procedure Code (CPT/HCPCS) and any Additional Procedure Codes
Diagnosis Code(s) (ICD-10)
Start Date or Admission Date (MMDDYYYY) and Discharge Date or Length of Stay
Modifiers as applicable

Denial Risk

Authorization vs payment

An authorization determination is not a guarantee of payment. Member eligibility, covered benefits, and medical necessity at the time services are rendered affect payment.

Authorization must be obtained prior to services when required by the plan
Member must be eligible on the date of service and the service must be a covered benefit
Payment is subject to medical necessity review and plan policy

Prior Authorization

Behavioral health routing

Behavioral health inpatient requests must be sent to the behavioral health fax number to ensure proper routing and timely review.

Behavioral Health Requests Fax: 855-663-2244
Label urgent behavioral health requests appropriately per physician signature requirements

Key Definitions

Urgent request — definition and response timeframe

DefinitionAn urgent request is a non–life-threatening request certified as urgent to treat an injury, illness, or condition to avoid complications, unnecessary suffering, or severe pain.

Physician signatureUrgent requests must be signed by the physician to receive priority handling.

Response timeframe72 hours from receipt for certified urgent (non–life-threatening) requests to avoid complications.

Authorization — definition and verification note

DefinitionAuthorization is a determination that is not a guarantee of payment.

Eligibility and coverageMember must be eligible at the time services are rendered and services must be a covered benefit.

Medical necessityServices must be medically necessary and have prior authorization as per the plan policy and procedures to be payable.