Providers billing for professional services and medical suppliers must complete the CMS-1500 (02/12) form. Providers should purchase these forms from a supplier of their choice. Health Net does not supply claim forms to providers. Copies of the form cannot be used for submission of claims, since a copy may not accurately replicate the scale and OCR color of the form. To reduce document handling time, providers must not use highlights, italics, bold text, or staples for multiple page submissions. These claims will not be returned to the provider. Claims submitted on black and white, handwritten or nonstandard forms will be rejected and a letter will be sent to the provider indicating the reason for rejection. Paper claim forms must be typed in black ink with either 10 or 12 point Times New Roman font, and on the required original red and white version to ensure clean acceptance and processing. Health Net only accepts standard claim forms printed in Flint OCR Red, J6983 (or exact match) ink. Requirements for paper forms are described below. Refer to electronic claims submission for more information.įor providers unable to send claims electronically, paper claims are accepted if on the proper type of form. Health Net prefers that all claims be submitted electronically. Health Net recommends that self-funded plans adopt the same time period as noted above. This in no way limits Health Net's ability to provide incentives for prompt submission of claims. Health Net will determine "extraordinary circumstances" and the reasonableness of the submission date. Health Net will waive the above requirement for a reasonable period in the event that the physician provides notice to Health Net, along with appropriate evidence, of extraordinary circumstances that resulted in the delayed submission. Health Net will process claims received within 365 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, when Health Net is the secondary payer. Note: where contract terms apply, not all of this information may be applicable to claims submitted by Health Net participating providers. This information pertains to claims for services rendered by providers to Health Net members in all products offered by Health Net. HMO/POS/HSP, PPO, Centene Corporation Employee Self-Insured PPO PLAN, & programsĬal MediConnect – Los Angeles MediConnect – San Diego CountyĬlaims Settlement and Dispute Resolution Mechanism Contact the applicable Health Net Provider Services Center at:.Your clearinghouse should be able to assist with sending Health Net an electronic eligibility inquiry. Use the EDI Eligibility Benefit Inquiry and Response – this electronic transaction facilitates the verification of a member's eligibility and benefit information without the inconvenience of a phone call.To verify eligibility, providers should either: Due to ongoing changes in eligibility, the best practice is to confirm eligibility no more than one day prior to providing a prior-authorized service. Health Net requires that providers confirm eligibility as close as possible to the date of the scheduled service. All managed care plan beneficiaries with pre-existing provider relationships who make a continuity of care request must be given the opportunity to request coverage of continued treatment for up to 12 months with the out-of-network provider. Purpose: Beneficiaries who are transitioning from fee-for-service into a managed care plan have the right to request continuity of care, such as completion of care from current providers in accordance with the state law and the health plan contracts, with some exceptions. The following policies and procedures apply to provider claims for services that are adjudicated by Health Net of California, Health Net Life Insurance Company, and Health Net Community Solutions "Health Net", except where otherwise noted.Ĭontinuity of Care Request Forms – for Members Information for Non-participating Providers: California
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