Overview

A participating provider that expands its capacity by adding new or satellite facilities or new participating physicians or other subcontracting providers must notify Health Net in writing at least 90 days before the addition. According to the terms of the Provider Participation Agreement (PPA), the participating provider agrees that Health Net has the right to determine whether the new or satellite facilities or the new participating physicians are acceptable to Health Net.

Addition of New Physicians, Providers or Facilities

Until Health Net approves new subcontracting providers (for example, primary care physicians (PCPs), specialists and ancillary providers), the providers are not allowed to provide covered services under the Health Net Provider Participation Agreement (PPA). Health Net must be notified in writing at least 90 days before the addition.

Health Net is free to deny participation to any new subcontracting providers and is not obligated to state a cause or explain the denial of the addition or provide the facility, provider or subcontracting providers with any right to appeal or any other due process. Health Net's decision in these cases is final and binding.

In addition, hospitals and ancillary providers are responsible for providing Health Net with copies of the standard agreements used for their subcontractors. Health Net reviews these standard agreements to ensure compliance with regulatory requirements and directs the facility to make any changes required in order to meet the requirements. Health Net requires hospitals and ancillary providers to send sample forms to Health Net for review if they make any changes to their standard agreements or replace them with new standard agreements.

Hospitals and ancillary providers must provide Health Net with a copy of the signature page for each subcontractor. Physicians or other subcontractors must be credentialed before they are added to Health Net's network. Hospitals and ancillary providers must also provide Health Net a list of the names, locations and federal tax identification numbers (TINs) of all of its participating providers.

Hospitals and ancillary providers are also responsible for informing Health Net when they cease to use a specific subcontractor or when they add a new subcontractor. Health Net periodically sends each hospital and ancillary provider a list of the physicians or subcontractors Health Net shows as active and under contract with the participating provider. Hospitals and ancillary providers are required to review this list and notify Health Net of any additions or deletions. At least monthly, hospitals and ancillary providers must provide Health Net with a list of additions, deletions and address changes, as well as a complete listing annually.

Hospitals and ancillary providers must furnish Health Net copies of any amendments to a contract with a participating provider within 20 days of execution.