Error Notification
Provider Type
- Participating Physician Groups (PPG)
- Ancillary
- Hospitals
Encounter data submitted to Health Net can fail at the file level or the encounter level. If there is a file failure, the submitter is notified by the Capitated Claims/Encounter Department. The file must be corrected and resubmitted.
Common causes of performance issues
- Missing or invalid provider information such as:
- National Provider Identifier (NPI)
- Use of Type 2 (organizational) NPIs for rendering/attending provider instead of required Type 1 (individual) NPIs.
- National Plan and Provider Enumeration System (NPPES) NPI validation: Submitted NPI data is required to match the NPI and qualifier submitted in 837 file.
- Duplicate encounter submissions.
- Delays in correcting DHCS denied encounters.
- Billing errors, including:
- Invalid diagnosis-related groups (DRGs)
- Invalid or missing National Drug Codes (NDCs) (numbers, units of measure, quantity)
- Invalid or missing Bill Types
If the encounter file passes on to encounter level edits, the following reports are produced:
- Claims/Encounters Control Summary Reports - reports receipt/accept/reject totals for reconciliation.
- Encounter/Claims Rejection Report - identifies specifics for encounters that failed edits and require correction and resubmission.
Note: When correcting claim line(s) the entire claim must be resubmitted, rather than just the corrected line(s).
Contact the Capitated Claims/Encounter Department if record-specific resubmission cannot be generated.