Provider Portal for Authorization
Health Net has a variety of methods or contracted Community Supports (CS) providers to submit an authorization request. However, it is recommended to submit through the provider portal. The provider portal is a secure web-based platform that can be used to verify a member for their current eligibility status and access to real-time status updates.
CS providers can create new authorizations and follow the step-by-step guidance to complete an authorization request for the CS service(s). See CS end-to-end process.
- Log in to the provider portal.
- Verify member is eligible with Health Net and qualifies for CS (use CS authorization guides as a tool to determine member qualifications): CS authorization guides.
- Click on the Auth tab and select create a new auth.
- Under service type select the option for Community Supports.
- Enter your National Provider Identifier (NPI) as the requesting and servicing provider.
- Enter the diagnosis codes that help determine the member’s eligibility.
- Attach any documents (i.e. assessment, diagnosis) that support the authorization request.
- Enter all other requested information including service, procedure code, etc., and click submit.
Supporting Documentation
Supporting documentation must be submitted with the authorization request in order to confirm member eligibility. Supporting documents can be attached to the authorization request in the provider portal and minimize delays in determining the authorization request. All requests must include the most up-to-date version of the CS authorization forms when submitting supporting documents.
Authorization Review Process
Health Net will enter the request into Health Net’s clinical documentation system to track and monitor all authorizations and validate the member’s benefit and eligibility. Health Net will process requests and make a determination based on medically appropriate criteria.
Determinations can be viewed in the provider portal in real time. A letter informing the member and referring/servicing provider will be sent as confirmation. The timing of decisions will be consistent with the urgency of the member situation. Examples of urgent services would be recuperative care, housing navigation and housing deposits. Expedited authorizations for time-sensitive CS services will be processed within 72 hours and routine requests will be processed within seven calendar days. Turnaround time is dependent on the receipt of all clinical information necessary to render a decision.