Acknowledgement and reimbursement of claim

Acknowledgement of Claims - Health net

Health Net provides an acknowledgement of claims receipt, whether or not the claims are complete, within two working days for electronically submitted claims. For paper claims, Health Net is required to provide an acknowledgement of claims receipt within 15 working days for HMO, POS, AIM, Healthy Families Program, and Medi-Cal claims and within 15 calendar days for PPO, EPO, and Flex Net claims. If a paper claim is paid or denied within 15 days, the Remittance Advice (RA) is also considered an acknowledgement of claims receipt. A provider may obtain an acknowledgement of claim receipt in the following manner:
•    HMO, POS, PPO, EPO, Flex Net, AIM, and Healthy Families
•    Program claims: Electronic fax-back confirmation of claims receipt through the Provider Services Center interactive voice response (IVR) system and via a paper acknowledgement report mailed within 15 days of claim receipt
•    Medi-Cal claims: Confirmation of claims receipt by calling the Medi-Cal Provider Services Center at (800) 675-6110
Claims received from a provider's clearinghouse are acknowledged directly to the clearinghouse in the same manner and time frames noted above.
Date of Receipt
Date of receipt is the working day when a claim is first delivered, electronically or physically, to Health Net's designated address.


Reimbursement of Claims
Health Net reimburses each complete claim, or portion thereof, from a provider of service no later than 30 working days for PPO, EPO, Flex Net, and Medi-Cal claims and 45 working days for HMO, POS, Access for Infants and Mothers (AIM), and Healthy Families Program claims after receipt of the claim unless the claim is contested or denied. Health Net reserves the right to adjudicate claims using reasonable payment policies and non-standard coding methodologies. These policies and methodologies are consistent with available standards accepted by nationally recognized medical organizations, federal regulatory bodies and major credentialing organizations.