- Participating Physician Groups (PPG)
A tracer is a request for Health Net to research the status of a previously submitted claim that, according to the provider's records, has not been processed. If the claim has been processed (paid or denied), it should not be marked as a tracer. If the provider is disputing the payment amount or denial of a claim, it must be submitted as a provider dispute (refer to the Overview discussion in the Provider Appeals and Dispute Resolution section under the Appeals and Dispute Resolution topic for more information).
Identify a claim that is a tracer by writing or stamping "TRACER" prominently in a blank area of the claim form.
Tracers for Medi-Cal claims must be submitted within 12 months after the date of service and must include all necessary supporting documentation, such as other carrier payment information, chart notes and referral information. Tracers that are received after 12 months are denied for exceeding the timely filing deadline, unless providers can show proof (through such means as explanation of coverage or benefits, or correspondence) that the claim was received by Health Net and subsequently followed up in a timely manner by the provider.
Providers should include documentation with each tracer claim, showing the previous dates that the provider has submitted the claim and explain if the provider sent the claim to any addresses other that the designated Health Net Medi-Cal Claims address.
Participating providers may not balance-bill members at any time, including while tracer claims are under consideration.