Provider Manual

  • Refer to the Cal MediConnect Provider Operations Manual for dates of service prior to January 1, 2023.
  • Refer to the Medicare Advantage (MA) Provider Operations Manual for dates of service January 1, 2023, and beyond. The MA provider operations manual is updated to support D-SNP.

The Health Net Cal MediConnect Operations Manual provides important plan benefits, limitations and administration processes for Health Net participating providers to make sure members enrolled in the Cal MediConnect plan receive covered services when needed. The Cal MediConnect plan is regulated by the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Care Services (DHCS) pursuant to a 3-way contract between Health Net Community Solutions, Inc. (Health Net) and these government agencies.

The three provider types - Participating Physician Groups (PPGs), Hospitals and Ancillary - are listed at the top of every page. In certain instances, you may see a fourth provider type listed, Physicians. When a Physician provider type is listed, you will be notified that content does not apply to Cal MediConnect. Refer to the Provider Type listed at the top of the page to see if the content applies to you.

As a Health Net participating provider, you are required to comply with applicable CMS and DHCS regulations, as well as Health Net policies and procedures.

The contents of the Cal MediConnect Operations Manual is in addition to your Provider Participation Agreement (PPA), its addendums, Schedule of Benefits, or the Member Handbook. When the contents of the Cal MediConnect Operations Manual conflicts with the PPA, the PPA takes precedence.