California Policies and Procedures - Healthnet - Eligibility verification

For Non-participating Providers

Eligibility Verification
Health Net requires that non-participating providers re-verify eligibility as close to the date of the scheduled service as possible. Due to ongoing changes in eligibility, the best practice is to re-verify eligibility no more than a day prior to providing a prior authorized service.

To verify eligibility contact the applicable Health Net Provider Services Center at:

Line of Business                                                            Contact Information
HMO/POS, PPO, and EPO                                               (800) 641-7761
Healthy Families Program, Healthy Kids and AIM              (888) 231-9473
Medi-Cal                                                                            (800) 675-6110

Claim Filing Timeframe

Health Net accepts claims from HMO, POS, PPO, EPO, Flex Net, AIM, and Healthy Families Program non-participating providers if they are submitted within 180 calendar days from the date of service except as described below. If Health Net is not the primary payer under coordination of benefits (COB) rules, the claim submission period begins on the date the primary payer has paid, contested or denied the claim. Claims not received within the timely filing period are denied.

If a claim is denied for timely filing but the provider can demonstrate "good cause for delay" through the provider dispute resolution process, Health Net accepts and adjudicates the claim as if it had been submitted within the provider's claim filing timeframe.

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