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
provider_services@healthnet.com
Healthy Families Program, Healthy Kids and AIM (888) 231-9473
provider_services@healthnet.com
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.
Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Pages
- Home
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do

California Policies and Procedures - Healthnet - Eligibility verification
Labels:
Insurance,
Insurance verification process
Subscribe to:
Post Comments (Atom)
Medical Billing Popular Articles
-
CPT CODE AND Description 99391 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age...
-
Procedure CODES and Descriptions 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an indi...
-
CPT Code and description 99381 - Initial comprehensive preventive medicine evaluation and management of an individual including an age an...
-
CPT code and description 80050 - General health panel This panel must include the following: Comprehensive metabolic panel (80053), ...
-
Procedure code and Description 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A pro...
-
Medicare denial code and Descripiton 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent ...
-
93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers Whether you call them ECGs or EKGs, chances are you see a lot of elec...
-
When an ERA is received, providers may: •Post decision and payment information automatically, for individual claims included in an R...
-
Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the cla...
-
Background: Type of Service (TOS) is an indicator that the contractor places on the Form CMS-1500 paper form or electronic format. The indic...

No comments:
Post a Comment