Confirm Member Eligibility
Community Supports (CS) providers are required to verify member’s health plan eligibility. The member’s eligibility must be confirmed during initial contact to make sure the member qualifies for CS services and/or is enrolled in any duplicative care coordination programs. For additional information on qualification criteria for any of the covered CS services, CS providers can access the CS authorization guides. Thereafter, CS providers must submit a CS authorization form for CS services requiring prior authorization. Authorization forms can be submitted through the provider portal or fax the request to Health Net and determinations can be viewed in the provider portal in real time. If the member meets the CS eligibility criteria, the provider will be authorized to conduct CS services for the member. A letter informing the member and referring/servicing provider will be sent as confirmation.
If there is not enough information included with the referral to confirm CS program eligibility, Health Net will request additional information. Based on information received, Health Net will render a decision to authorize or deny services.
CS providers should not request an authorization for any CS services until the member has been reached, screened and agreed to the service provided.