CurrentCentenePolicy N/A

Medicare Inpatient Authorization — Health Net California

This document governs prior authorization request completion and submission for Medicare inpatient admissions for Health Net California (Centene) members; it affects requesting and servicing providers and facilities submitting standard or expedited authorization requests.

Policy Summary

PayerCentene

PolicyMedicare Inpatient Authorization — Health Net California

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionComplete the inpatient authorization form and fax to the provided number; include copies of all supporting clinical information.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7 daysstandard determination timeframe

physician signatureexpedited request requirement

2 numberssubmission fax numbers

multipleinpatient service types listed

requiredsupporting clinical info

Inpatient Authorization Coverage Criteria

Inpatient authorization submission criteria

Submission and decision criteria for inpatient authorization requests

All required fields marked on the form must be completed; incomplete forms will be rejected.

Copies of all supporting clinical information are required; lack of clinical information may result in a delayed determination.

Authorizations are not a guarantee of payment; member must be eligible at time of service, services must be covered benefits and medically necessary per plan policy.

Timing and priority

Standard (Elective) request: Determination will be made as expeditiously as the enrollee's condition requires but no later than 7 calendar days after receipt of the request.

Policy Summary

PayerCentene

PolicyMedicare Inpatient Authorization — Health Net California

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionComplete the inpatient authorization form and fax to the provided number; include copies of all supporting clinical information.

SourceLink

On This Page

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Procedure, Diagnosis, and Service Type Codes

Procedure and diagnosis codesmixed

CPT/HCPCS	Primary and additional procedure codes requested on the form
ICD-10	Diagnosis code required

Inpatient service type numeric codes (examples)mixed

402	Skilled Nursing Facility (service type code)
492	Sub-Acute (service type code)
411	Surgical (service type code)
992	Transplant (service type code)
720	Vaginal Delivery (service type code)
779	C-Section Delivery (service type code)
970	Medical (service type code)
414	Premature/False Labor (service type code)
427	Rehab (service type code)
121	Long Term Acute Care (service type code)

Required fields

Required form completionAll required form fields (marked with an asterisk) must be completed; incomplete forms will be rejected.

Required clinical identifiersMember last name, first name, date of birth, and Member ID must be provided where indicated.

Procedure and diagnosis fieldsPrimary procedure (CPT/HCPCS), any additional procedure codes, and diagnosis code (ICD-10) must be entered in their designated fields.

Dates and service countsStart/admission date and end/discharge date (MMDDYYYY) plus total units/visits/days must be completed when applicable.

Provider Submission Steps and Timelines

Prior Authorization

Submit form, standard determination timeframe, and expedited request rules

Complete the Medicare inpatient authorization form and fax it to the appropriate number. For standard (elective) admission requests, determinations are made as expeditiously as the enrollee's health condition requires but no later than 7 calendar days after receipt of the request. Expedited requests are for situations where waiting could seriously jeopardize the enrollee's life, health, or ability to regain maximum function and must be signed by the physician to receive priority.

Standard (elective) fax number: 844-501-5713
Behavioral health fax number: 855-663-2244
Expedited requests require physician signature to receive priority

Documentation Required

Attach supporting clinical documentation and use correct fax

Include copies of all supporting clinical information when submitting the form; all required fields must be completed. Incomplete forms may be rejected and lack of clinical information may delay determination. Use the general fax number for routine submissions and the behavioral health fax for BH-specific requests.

All required fields must be filled in; incomplete forms will be rejected
Copies of all supporting clinical information are required; lack may delay determination
Fax general submissions to 844-501-5713; BH-specific requests to 855-663-2244

OpenPayer

Medicare Inpatient Authorization — Health Net California

Inpatient Authorization Coverage Criteria

Procedure, Diagnosis, and Service Type Codes

Provider Submission Steps and Timelines

Request Type Definitions