Using Our Online Form for Authorization Change Requests

Wednesday, May 10, 2023

There may be times when you need to request a change to services already approved by Health Net Federal Services, LLC (HNFS). We offer an online Outpatient Authorization Change Request form. Use this form to request changes to outpatient authorizations within 30 days of approval, such as:

Servicing provider
Priority level
CPT®, HCPCS®, or diagnosis codes (some exceptions apply)
Procedure or service dates

You must be listed as the requesting or servicing provider on the existing authorization. HNFS processes requests within five business days. Check the status on our Check Status page.

Please do NOT use this form:

If it has been more than 30 days since HNFS’ approval.* Submit a new request instead.
To add services or extend visits/units. Submit a new request instead.
- Tip: For services like physical/occupational/speech therapy and allergy visits, you can use a generic request type (e.g., P106) and specify codes needed for treatment.
For services already rendered.
To submit new referrals/authorizations.
To change/add codes or dates on an approved initial evaluation.
To submit medical documentation.
To request changes to applied behavior analysis (ABA) services authorized under the Autism Care Demonstration (ACD). Contact our dedicated ACD line for assistance.
To submit questions to customer service.

*HNFS will allow corrections outside the 30-day window in specific cases.