Notification of Hospital Admissions
Provider Type
- Physicians and Practitioners
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Reporting Requirement
Hospitals are required to notify Health Net of any Health Net member inpatient admission within:
- 24 hours, or
- One business day when the admission occurs on a weekend or holiday
Notifications are required 7 days a week and must be submitted to the Hospital Notification Unit.
Failure to Notify
Failure to notify Health Net in accordance with the requirements outlined in the Provider Participation Agreement (PPA) may result in a denial of payment.
Tracking Number and Authorization
Upon receipt of an admission notification:
- Health Net creates a tracking number and provides it to the reporting party.
- The tracking number is not an authorization and does not, by itself, confirm coverage under the member’s benefit plan.
- Any services authorized by Health Net at the time of notification or thereafter are documented in the Health Net notification system.
- The tracking number is also transferred electronically to the Health Net claims processing system.
How to Report an Admission
To report a Health Net member inpatient admission, contact the Health Net Hospital Notification Unit.
After‑Hours Admissions
- Notifications for after‑hours admissions may be submitted via fax or web.
- On the next business day, a Health Net representative:
- Verifies member eligibility.
- Obtains admission details.
- Issues a tracking number, if applicable.
When reporting inpatient admissions, a hospital face sheet may be submitted. If a hospital face sheet is not submitted, the following information must be provided:
- Member name.
- Subscriber identification (ID) number.
- Attending and admitting physicians' first name, last name and contact information.
- Admission date and time of admission.
- Admission type (such as emergency room, elective or urgent).
- Facility name and contact information.
- Level of care.
- Admitting diagnosis code.
- CPT procedure code, if available.
- Facility medical record number.
- Participating physician group (PPG) authorization number (if applicable).
- For obstetrical (OB) delivery admissions, include newborn sex, weight, Apgar score, time of birth, and medical record number.
- Discharge date, if applicable.
- Other insurance information, if applicable.
Timely notification of Health Net member inpatient admissions assists with timely payment of claims, reduces retroactive admission reviews and enables Health Net to concurrently monitor member progress. Health Net requires hospitals to notify the Hospital Notification Unit and the PPG (if applicable) or provider of a member's inpatient admission within 24 hours (or one business day when an admission occurs on a weekend or holiday) for the following services:
- All inpatient hospitalizations.
- Skilled nursing facility (SNF) admissions.
- Inpatient rehabilitation admissions.
- Inpatient hospice services.
- Emergency room admissions.
Electronic medical records or administrative system
In accordance with the Provider Participation Agreement (PPA) and Federal regulation 42 CFR 482.24 section (d) , hospitals and facilities must ensure compliance and prompt electronic notification of patient discharges and transfers. The following organizations have been designated as qualified health information organizations (QHIOs) and are available to assist with Data Exchange Framework (DxF) requirements:
- Los Angeles Network for Enhanced Services (LANES)
- Manifest MedEx
- SacValley MedShare
- San Diego Health Connect
- Applied Research Works, Inc.
- Health Gorilla, Inc.
- Long Health, Inc.
- Orange County Partners in Health-Health Information Exchange (OCPH-HIE)
- Serving Communities Health Information Organization (SCHIO)
Requests for Authorization for Post-Stabilization Care at Non-Participating and Participating Hospitals
Health Net is responsible for the coverage and payment of emergency services and post-stabilization care services to the provider that furnishes the services. This can be a participating provider, subcontractor, downstream subcontractor, or nonparticipating provider.
Requests for Post-Stabilization Authorization
The requirement to request authorization applies to both in-network and out-of-network hospitals when treating members. Refer to Request for Authorization to Provide Post-Stabilization Services at Non- Participating and Participating Hospitals for detailed information on how to request a post-stabilization authorization.