Reimbursement Timelines and Penalties for Late Claims
Provider Type
- Physicians and Practitioners
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Claims received on or after January 1, 2026 must be reimbursed fully or partially within 30 calendar days of receipt. If a claim is incomplete, the physician or other provider must be notified as soon as possible, and no later than 30 calendar days after receiving the claim.
Interest and Penalty Payments for Late Claims
Late paid claims must include interest at the rate of 15% per annum beginning with the first calendar day after the 30-calendar day period.
Failure to automatically include all interest that has accrued on a late payment of a claim requires a penalty payment to the claimant the greater of either an additional $15 or 10% of the accrued interest on the claim.
Member Complaints
Member complains about a delay or denial of payment of a claim must be treated as a grievance, subject to Health Net’s grievance process. Refer to the Grievances section below for more information.