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. 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, & MediConnect – Los Angeles MediConnect – San Diego 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. Continuity of Care Request Forms – for Members
0 Comments
Leave a Reply. |