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Professional Claim Editing

Provider Type

  • Physicians

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Riverside
  • Sacramento
  • San Bernardino
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

Health Net has a contractual relationship with iHealth Technologies, Inc. (iHT) to provide a technology solution for professional claim edit policy management. Using iHT's services, Health Net has the ability to apply advanced contextual processing for application of Health Net edit logic.

The process is as follows:

  • Health Net customizes and controls the selection of all edit policy
  • Claims are transferred through various interfaces to iHT every night
  • iHT reviews each claim in the file and renders coding recommendations based on Health Net's edit policy

iHT also provides management support services, including edit policy advisory services. The iHT Medical Policy team conducts ongoing research into payment policy sources including, but not limited to, the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA) and other specialty academies, to provide Health Net with the necessary information to make informed decisions when establishing edit policy.

Last Updated: 08/05/2021