PCP Selection and Assignment
- Participating Physician Groups (PPG)
If a member does not select a primary care physician (PCP) at the time of enrollment, Health Net assigns one to allow member access to medical care immediately upon enrollment.
The following assignment process is used:
- In auto-assigning a PCP, the system searches for a PCP within 10 miles or 30 minutes of the member's residence.
- Health Net considers the language preference of the member. The system searches for a PCP who is fluent in the member's preferred language or who has staff fluent in it.
Health Net also considers families. Family members over age 14 are assigned to the same PCP to help make appointment scheduling easier for the family. Children ages 14 and younger are assigned to a pediatrician if one is available who meets the geographic and language preference criteria. All such children are assigned to the same pediatrician
Primary Care Physician Changes
Health Net reimburses fee-for-service (FFS) Medi-Cal primary care physicians (PCPs) only for services provided to a Health Net Medi-Cal member assigned to the PCP at the time the care is provided. When a Health Net member seeks care from a PCP to whom the member is not assigned, a change in PCP assignment must be made prior to providing care in order for the claim to be paid. This is done by completing and faxing a Request for PCP/PPG Change form (English (PDF) or Spanish (PDF)) with the following information to the CalViva Health Member Services Department:
- The effective date the member changed to a new PCP
- The member or the member's legal guardian's signature on the Request for PCP/PPG Change form (changes can only be made if the form is signed)
Allow five days from the date of faxing the form for the PCP change to be entered into Health Net's records.
Providers should submit a copy of the Request for PCP/PPG Change form with their claims to ensure timely payment of the claims.
Members also have the option of contacting the CalViva Health Member Services Department by telephone to request a PCP change.
Members requesting a primary care physician (PCP) change may complete a Request for PCP/PPG Change form (English (PDF) or Spanish (PDF)) and fax it to the Health Net Medi-Cal Member Services, or contact the Medi-Cal Member Services Department by phone to request the change Department.