Skip to Main Content
HealthNet.com
Enter Keyword
Search
Provider Login
Line of Business
Medi-Cal
Medicare Advantage
EPO
HMO
HSP
PPO
Prison Health Care Provider Network
Provider Login
Line of Business
Medi-Cal
Medicare Advantage
EPO
HMO
HSP
PPO
Prison Health Care Provider Network
SEARCH
MENU
Go!
HealthNet.com
Medi-Cal
CalAIM
Community Supports
Enhanced Care Management (ECM)
Provider Manual
Adverse Childhood Experiences (ACEs)
Appeals, Grievances and Disputes
Member Appeals
Provider Appeals and Dispute Resolution
Grievances
Benefits
Access to Sensitive Services
AIDS
Alcohol and Drug Abuse
Acupuncture
Ambulance
Autism Spectrum Disorders
Behavioral Health
Chiropractic
Clinical Trials
Cognitive Health Assessment
Cosmetic and Reconstructive Surgery
Dental Services
Dialysis
Doula Services
Durable Medical Equipment
Dyadic Services
Enteral Nutrition
Family Planning
Hearing/Hearing Aids
HIV Testing and Counseling
Home Health Care
Hospice Care
Immunizations
Incontinence Medical Supplies
Initial Health Appointment
Injectables
Long-Term Care
Maternity
Nurse Midwife
Obesity
Podiatry
Preventive Services
Preventive and Screening Services Under Age 21
Primary Care
Principal Exclusions and Limitations
Second Opinion by a Physician
Street Medicine Services
Subacute Care Facilities
Support for Disabled Members
Transgender Services
Transplants
Transportation
Vision
X-Ray and Laboratory Services
Claims and Provider Reimbursement
Remittance Advice and Explanation of Payment System
Tracers
Accessing Claims on the New Health Net Portal
Adjustments
Balance Billing
Billing and Submission
Capitated Claims Billing Information
Telehealth Billing Requirement
Emergency Claims Processing
Fee-For-Service Billing and Submission
Professional Claim Editing
Refunds
Reimbursement
Federally Qualified Health Centers Alternative Payment Methodology
Targeted Rate Increase
Claims Processing for DSNP in EAE Counties
Claims Coding Policies
Add-On Codes
Allergy Services with Evaluation and Management Services
Assistant Surgeons (State Health Programs)
Basic Coding Guidelines
Bilateral Procedures
Bundled Services and Supplies (State Health Programs)
Co-Surgeons (State Health Programs)
Global Surgery
Incident to Services
Modifier -59
Claim Editing
Provider-Preventable Conditions
Compliance and Regulations
Mandatory Data Sharing Agreement
Provider Marketing Guidelines
Provider Offshore Subcontracting Attestation
Communicable Diseases Reporting
DMHC-Required Statement on Written Correspondence
Federal Lobbying Restrictions
Health Net Affiliates
Material Change Notification
Nondiscrimination
Drug Utilization Review Requirements
Consent
Consent for Breast and Prostate Center Treatment
Consent for Treatment
Human Sterilization and Informed Consent
Coordination of Benefits
Overview
Copayments
Verifying and Clearing Share-of-Cost
Credentialing
Application Process
Site Evaluations
Denial Notification
Denial Letter Translation Assistance for Members
Notification Delays
Required Elements for Member Notification Letters
Required Elements for Provider Notification Letters
Requirements for Notification of Utilization Management Decisions
Disenrollment
Eligibility
Eligibility Verification
Children
Share of Cost for Medi-Cal Members
Eligibility Reports
Eligibility Reports
Molina Healthcare Eligibility Reports
Emergency Services
Coverage Explanation
Additional Monitoring Responsibilities
Hospital Request for Authorization to Provide Post-Stabilization Services
Out-of-Area Emergency or Urgently Needed Care
PPG Responsibilities
Procedures to Report System & Protocol Failures
Encounters
Overview
Dual-Risk Contracts Encounter Data Submission
Error Notification
Noncompliance with Encounter Data Submission
Professional and Institutional Capitated Encounter Submission Requirements
Enrollment
Member Enrollment
Use of Social Security Numbers
ID Cards
Member ID Card
Medical Records
Confidentiality of Medical Records
Medi-Cal Medical Records Reviews
Medical Record Documentation
Member Rights and Responsibilities
Overview
Advance Directives
Member Confidentiality
PCP Selection and Assignment
Prescription Drug Program
Prior Authorizations
Requesting Prior Authorization or Coordinating a PCP Referral
Advanced and Cardiac Imaging
How to Secure Prior Authorization on the Provider Portal
Notification of Inpatient Admissions
Prior Authorization
Request for Prior Authorization Form
Services Not Requiring Prior Authorization
Peer-to-Peer Review Requests
Product Descriptions
Medi-Cal Managed Care
Provider Oversight
Appeals and Grievances
Calendar of Required PPG Submissions
Conditions of PCP Panel Closures by Health Net
Corrective Action Plan
Credible Allegations of Fraud
Fraud, Waste and Abuse
Provider Enrollment Requirement Through DHCS
Monitoring Provider Exclusions
Sub-Delegated Functions
Contractual Financial and Administrative Requirements
Delegated Medical Management
Facility and Physician Additions, Changes and Deletions
Service and Quality Requirements
Provider Oversight Overview
Public Programs
Medi-Cal Waiver Program (formerly AIDS Waiver Program)
Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment
California Children's Services
DDS-Administered Home and Community Based Services (HCBS) Waiver
Early Start Program
EPSDT / Medi-Cal for Kids & Teens Services
Home and Community Based Waiver
Local Education Agency Services
Long-Term Services and Supports
Mental Health
Sexually Transmitted Infections (STIs)
Tuberculosis Detection and Treatment
WIC
Quality Improvement
Disease Management Programs
Facility Site Review
Language Assistance Program and Cultural Competency
Medi-Cal Quality Improvement Programs
Health Education
Quality Improvement Program
Referrals
Investigational and Experimental Treatment
Molina Healthcare Lab Referrals
Molina Healthcare Service Request Form
Primary Care Services
Receipt of Specialist's Report
Referral Tracking
Referrals for Specialty Consultation
Referrals to Specialists
Services Not Requiring Referral or Prior Authorization
Standing Referrals to a Specialist
Third-Party Liability
Overview
Provider Responsibilities
Urgent Care
Utilization Management
Overview
Nurse Advice Telephone Triage and Screening Program
Affiliated Health Plan Delegated Utilization Management - Reporting
Care Coordination
Care Management
Clinical Criteria for Medical Management Decision Making
Clinical Criteria for Utilization and Care Management Decisions
Concurrent and Retrospective Review
Continuity of Care
Discharge Notification
Hospital and Inpatient Facility Discharge Planning
Notification of Hospital Admissions
Out-of-Area Service
Prescription Utilization Review
Prior Authorization
Separation of Medical Decisions and Financial Concerns
Behavioral Health Provider Operations Manual
Prior Authorization Requirements
Participating Physician Group (PPG) Performance Scorecard
Payment Policies
Updates and Letters
Forms and References
Education, Training and Other Resources
Health Equity, Cultural and Linguistic Resources
Provider Pulse Newsletter
Contacts in Alphabetical Order
Glossary
Quality Management Program and Resources
Provider Manual Archive
County Relations/Service Coordination
Provider Manual Archive
2024
Medi-Cal Provider Manual - December 2024.pdf
Medi-Cal Provider Manual - August 2024.pdf
Last Updated: 08/13/2024
