Overview

Under Health Net's Cal MediConnect contract, Health Net and its subcontracting providers may claim for recovery of the value of covered services rendered to a member subject to Centers for Medicare and Medicaid Services (CMS) and DHCS lien and third-party recovery rights, if such recovery does not result from an action involving the tort liability of a third party or recovery from the estates of deceased members or casualty liability insurance, including workers' compensation awards and uninsured motorist coverage.

Health Net and its subcontracting providers are required to assist the DHCS in pursuing the state's right to reimbursement from such recoveries. Health Net and its PPGs are required to notify DHCS within 10 days of the discovery of such cases. On request from DHCS for information, Health Net and PPGs must provide additional information within 30 days of the request. Individual providers are obligated to help Health Net and affiliated PPGs provide the additional information on request.