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Requesting Outpatient Referral and Prior Authorization Changes

Providers can request changes to existing outpatient referrals or authorizations through our online Authorization Change Request Form. In order to complete your request, you must be listed as the servicing or requesting provider on the original referral/authorization and have the beneficiary’s first and last name, date of birth and original reference or authorization number. 

The following types of changes can be requested online:

  • servicing provider
  • priority of the request (urgent to routine)
  • CPT® or diagnosis codes*
  • procedure/surgery/service date(s)
  • number of visits/units**



Once submitted, your request will be processed within two business days. You can check the status of your authorization on our Check Status page.

Please do not use the Authorization Change Request Form to request new referrals/authorizations, submit medical documentation, request applied behavior analysis (ABA) changes, or for customer service inquiries.


*For outpatient physical health authorizations only. We cannot accept requests to add or change codes for outpatient specialty referrals or mental health authorizations.

**If a primary care manager (PCM) refers a patient specifically for consultation or evaluation only, Health Net Federal Services, LLC may only issue a referral for an initial consultation visit or an initial consultation and one follow-up visit. These requests cannot be extended.