Healthnet - Non participating provider tips

Information for Non-participating Providers

Implementation Processes

Currently, Health Net automatically denies claims for services rendered to a member who is no longer eligible as of the date of service. To comply with AB 1324, Health Net is modifying its existing claims adjudication process to no longer automatically deny claims for lack of eligibility, if the services have been provided in good faith and valid authorizations are submitted with the claims.

The Health Net system enhancements that are necessary to make this change to its claims adjudication process may not be complete by the AB 1324 effective date of January 1, 2008. Health Net is working diligently on systems implementation to ensure that claims are processed in accordance with the legislation. Initially some claims subject to AB 1324 may be denied inappropriately. To address this issue, Health Net has an interim process in place to identify these inappropriately denied claims and proactively adjust them to pay within the required 45-business-day time frame from the original date of receipt.

Non-participating providers have the Health Net provider dispute resolution process available to dispute any denied claims.