Get Soundpath Health Prior Authorization/Referral Form 2013-2024

Fax the completed form to the Prior Authorization Department at 1-800-743-1655.

Fax the completed form to the Prior Authorization Department at 1-800-743-1655.

The form a provider uses to request authorization is called a Prior Authorization ​(PA).

The form a provider uses to request authorization is called a Prior Authorization ​(PA).

Toll Free: 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the Member Services number: 1-877-658-0305).

Toll Free: 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the Member Services number: 1-877-658-0305).

Type or print; complete all sections. Attach sufficient clinical information to support medical necessity for services, or your request may be delayed. Fax the completed form to the Health Net Medi-Cal Prior Authorization Department at 1-800-743-1655.

Fax Submission Pharmacy providers and prescribers can submit a PA request via fax by utilizing the following approved forms: 50-1, 50-2, 61-211, or the Medi-Cal Rx PA Request Form, available January 1, 2022, in Reference Materials at .medi-calrx.dhcs.ca.gov/provider/forms/.

Type or print; complete all sections. Attach sufficient clinical information to support medical necessity for services, or your request may be delayed. Fax the completed form to the Health Net Medi-Cal Prior Authorization Department at 1-800-743-1655.

Fax Submission Pharmacy providers and prescribers can submit a PA request via fax by utilizing the following approved forms: 50-1, 50-2, 61-211, or the Medi-Cal Rx PA Request Form, available January 1, 2022, in Reference Materials at .medi-calrx.dhcs.ca.gov/provider/forms/.

Contact Member Services toll free at 1-800-675-6110 (TTY: 711), 24 hours a day, 7 days a week.

Contact Member Services toll free at 1-800-675-6110 (TTY: 711), 24 hours a day, 7 days a week.

Prior authorization or pre-authorization is a requirement from health insurance companies to ensure costly procedures are medically necessary. Doctors or medical providers are required to obtain prior approval before proceeding with a variety of procedures, diagnostics, medical devices, and prescription medications.

Prior authorization or pre-authorization is a requirement from health insurance companies to ensure costly procedures are medically necessary. Doctors or medical providers are required to obtain prior approval before proceeding with a variety of procedures, diagnostics, medical devices, and prescription medications.

You, your healthcare provider, or your authorized representative may submit a prior authorization via one of the methods listed above or via phone to (800)-535-9481 Monday through Friday, 8 a.m. to 6 p.m. Pacific time, excluding holidays.

You, your healthcare provider, or your authorized representative may submit a prior authorization via one of the methods listed above or via phone to (800)-535-9481 Monday through Friday, 8 a.m. to 6 p.m. Pacific time, excluding holidays.

Timely Filing of Claims When Health Net is the secondary payer, we will process claims received within 180 days after the later of the date of service and the date of the physician's receipt of an Explanation of Benefits (EOB) from the primary payer.

Timely Filing of Claims When Health Net is the secondary payer, we will process claims received within 180 days after the later of the date of service and the date of the physician's receipt of an Explanation of Benefits (EOB) from the primary payer.

California Health & Wellness provides the same benefits as Medi-Cal, plus more. In this section, you can learn about the health benefits, pharmacy services and value added services California Health & Wellness offers. Need help understanding these benefits and services?

California Health & Wellness provides the same benefits as Medi-Cal, plus more. In this section, you can learn about the health benefits, pharmacy services and value added services California Health & Wellness offers. Need help understanding these benefits and services?