Electronic Claims Submission

For electronic claim submissions check the current member identification (ID) for the correct payer ID.

The benefits of electronic claim submission include:

• Reduction and elimination of costs associated with printing and mailing paper claims.
• Improvement of data integrity through the use of clearinghouse edits.
• Faster receipt of claims by Health Net, resulting in reduced processing time and quicker payment.
• Confirmation of receipt of claims by the clearinghouse.
• Availability of reports when electronic claims are rejected.
• Ability to track electronic claims, resulting in greater accountability.

Reports

For successful electronic data exchange (EDI) claim submission, participating providers must utilize the electronic reporting made available by their vendor or clearinghouse. There may be several levels of electronic reporting:

• Confirmation/rejection reports from the EDI vendor
• Confirmation/rejection reports from the EDI clearinghouse
• Confirmation/rejection reports from Health Net

Providers are encouraged to contact their vendor/clearinghouse to see how these reports can be accessed/viewed. All electronic claims that have been rejected must be corrected and resubmitted. Rejected claims may be resubmitted electronically.

For questions regarding electronic claims submission, contact the Health Net EDI Department.