Health Net Medicare Programs Provider Services Department
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To ensure appropriate coverage of medical services for Medicare members, Health Net requires the provision of timely responses and accurate information an absolute necessity. If prompt and accurate information is not provided, a member may misuse the program, resulting in medical services not being covered. To avoid this issue, Health Net directs inquiries from members and employer groups to the Medicare Programs Member Services Department. Inquiries from participating physician groups (PPGs), hospitals, ancillary providers, and physicians are directed to the Provider Services Department, or the provider relations and contracting specialist (previously known as regional network administrators), where available.
The Provider Services Department telephone number is to be used exclusively by PPGs, hospitals and providers and should not be given to members.
During business hours (Monday through Friday, 8 a.m. to 5 p.m.), Health Net Provider Services Department representatives are available to assist providers with:
- Member eligibility and effective dates, and eligibility research.
- Questions about the Health Net prescription drug program.
- Conflict resolution regarding benefit interpretation.
- Exceptions and administrative decisions.
- Complaints regarding health care services, delivery of health care services or PPG staff.
- Request for removal of members for disciplinary actions.
- PPG transfer requests, other than address change or open enrollment.
- Questions regarding claim status.
Claims address:
Health Net of California, Inc.
800-929-9224 for all Medicare individual and Medicare employer group plans
800-641-7761 for all Medicare Supplement plans