Transition of Care
Provider Type
- Participating Physician Groups (PPG)
New members who are currently under or anticipate receiving behavioral health care should be instructed by their employer or participating physician group (PPG) to contact Health Net as soon as possible to ensure continuity of care and a smooth transition into the behavioral health program.
Once notified, Health Net begins case management and assumes financial responsibility for the case as of the effective date of the member's behavioral health care coverage or on the first day that Health Net is notified of a case it has inherited and has approved ongoing care.
When a member is confined to a hospital on the effective date of the behavioral health care coverage and remains hospitalized after the effective date of coverage, the original vendor is responsible for the member's care until the member is discharged or moved to a lower level of care. At that point, Health Net assumes responsibility.
All notification calls from the PPG are handled through Health Net's established intake procedures. The decision either to transfer the member to a Health Net provider or initiate Health Net's out-of-network authorization is based on established procedure.