II. Requesting Prior Authorization for Inpatient Post-Stabilization Services from CalOptima
For Medi-Cal or OCC Members, who are enrolled in CalOptima Community Network or CalOptima Direct-Administrative (collectively, CalOptima Direct), non-contracted hospitals must request prior authorization for medical necessary inpatient post-stabilization services from CalOptima before inpatient admission. CalOptima requires the treating physician to provide a diagnosis and sufficient information reasonably necessary to make a decision to authorize medically necessary inpatient post-stabilization services.