Inpatient Denial Log Submission

Hospitals must notify Health Net of a member's inpatient admission within 24 hours. In addition, Health Net requires delegated participating physician groups (PPGs) to submit information regarding denial of member inpatient admissions on a weekly basis.

Delegated PPGs are required to submit a weekly inpatient denial log (PDF) every Wednesday by close of business for the previous week's inpatient denials. If there are no denials, then the PPG must also submit a log that states that there were no denials for this time period. Providers must use the inpatient denial log and include the following information:

• member name
• member identification (ID) number
• admission and discharge dates
• number of days denied within the current length of stay and the date(s) of denied days
• type of service (for example, obstetrics (OB), skilled nursing facility (SNF), medical/surgical, or intensive care unit (ICU))
• admitting facility name
• authorization or denial number for each level of service during the length of stay
• disposition (such as discharged to home, SNF or hospice)

Submit weekly inpatient denial logs to Health Net via encrypted email, fax or mail.