Provider News January 2026 Pasadena, CA

2026 prior authorization list and updated medical necessity criteria now available

Imperial has posted the 2026 Prior Authorization List and updated Medical Necessity Criteria for Medicare Advantage providers.

Imperial Health Plan of California has published the 2026 Prior Authorization List along with updated Medical Necessity Criteria for the current plan year. Providers should review both documents to confirm which services require prior authorization and the clinical criteria used in coverage determinations.

What's changed

The 2026 documents reflect updated coding, clinical guideline references, and authorization requirements effective for the current plan year. Providers submitting authorization requests should reference the current versions to avoid processing delays.

Both documents are available on the Provider Forms & Resources page.

Questions

For questions about a specific authorization requirement, contact Member Services or submit a request through the EZ-Net Provider Portal.

Page last updated: September 29, 2026 at 12:00 PM PST (Build v5.7.237)

Disclosures

Medicare Advantage Plan Disclosures: Imperial Health Plan is an (HMO) (HMO SNP) with a Medicare Contract. Enrollment in Imperial Health Plan depends on contract renewal.

Imperial Health Plan of California (HMO) (HMO SNP) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Imperial does not exclude anyone or treat them unfairly because of race, color, national origin, age, disability, or sex. ATTENTION: If you speak English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-800-838-8271 (TTY: 711) or speak to your provider.

Individual & Family Plan Disclosures: Imperial Insurance Companies, Inc. and Imperial Health Plan of the Southwest, Inc. offer health insurance products through the ACA Health Insurance Marketplace in select states and are regulated by state Departments of Insurance and the federal Centers for Medicare & Medicaid Services where applicable.

For accurate plan information based on where you live, select your state and county. Plan availability, benefits, networks, premiums, and cost-sharing vary by line of business, state, and county. This information is not a complete description of benefits. Limitations, copayments, and restrictions may apply.