Hospital Liability Payment

In some instances, Health Net pays for services considered the primary hospital's liability, otherwise known as capitated services. The decision to pay hospital liability services typically occurs as a result of a quality assurance review.

Health Net requires that the primary hospital respond to Health Net and provide the necessary documentation demonstrating that the claim has been resolved via fax or mail within 10 calendar days of the hospital's receipt of Health Net's request for information. If the primary hospital does not provide an acceptable response to Health Net, Health Net may pay the claim on behalf of the hospital. Health Net may pay claims at the lesser of Health Net's contract rate with the provider, provider subcontract terms or provider's billed charges. Hospital liability claims that Health Net pays on behalf of the primary hospital are deducted from the monthly hospital services capitation.

Each hospital receives a copy of the monthly Hospital Liability Claims Paid in Error Report.