General Billing Guidelines

All claims must be submitted to Health Net within 120 days from the date the services were rendered. Health Net accepts claims submitted on the standard UB-04 (CMS-1450) form and computer-generated claims using these formats.

When using multi-part NCR forms, always submit the original, not second or third copies. Do not write or stamp information on the face of the claim. The physician's signature in box 13 or box 31 is acceptable. Health Net requires the following information on each claim:

• Member name
• Member identification number
• Member date of birth
• Health Net prior authorization number. Primary care physician (PCP) claims do not require prior authorization unless the services performed specifically require prior authorization
• Location where services were rendered
• ICD-10 diagnosis code
• Date of service
• Current year CPT or HCPCS code (physician) or UB-04 revenue code with narrative description (hospital)
• CMS place of service code (professional claims)
• CMS type of service code (professional claims)
• Number of days or units for each service line (professional claims)
• Billed charges
• Physician name, address, federal tax identification number, and National Provider Identifier (NPI)
• State license number of attending provider