PCP Selection and Assignment
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Selection Criteria
Newly enrolled members must choose a PCP within 30 days from the time they become a member of Health Net. If the member does not select a PCP, Health Net will choose one within 10 miles or 30 minutes of the member’s residence. The member can choose the same PCP or different PCPs, for all family members within Health Net, if the PCP is available.
If the member has a doctor they want to keep, or if the member wants to find a new PCP, they can go to the Provider Directory for a list of all PCPs and other providers in the Health Net network. The Provider Directory has other information to help the member choose a PCP. If the member needs a Provider Directory, the member can call the Member Services Department. The member may also find the Provider Directory on the Health Net website at www.healthnet.com
Primary Care Physician Changes
Fresno, Kings, Madera Counties
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 either calling the CalViva Health Member Services or CalViva Health Provider Services department or by having the provider or the member complete and fax the Request for PCP-PPG Change form – English (PDF) or Request for PCP-PPG Change form – Spanish (PDF) with the following information to the CalViva Health Member Services Department:
- The form must be completely filled out
- The provider must include the effective date the member changed to a new requested PCP/PPG
- The member or the member's legal guardian's signature must be on the Request for PCP/PPG Change form (changes can only be made if the form is signed and acknowledged by the member or member’s legal guardian).
- The Requested PCP Change form may take up to 15 days from the date of faxing the form for the PCP/PPG change to be completed and reflect on Health Net’s portal.
Allow five days from the date of faxing the form for the PCP change to be entered into Health Net's records.
Amador, Calaveras, Inyo, Kern, Los Angeles, Mono, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, Tulare and Tuolumne Counties
Members requesting a primary care physician (PCP) change may complete a Request for PCP-PPG Change form – English (PDF) or Request for PCP-PPG Change form – 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.
Imperial County
Members requesting a primary care physician (PCP) change may complete a Request for PCP-PPG Change form – English (PDF) and fax it to the Community Health Plan of Imperial Valley Member Services – English or Request for PCP-PPG Change form – Spanish (PDF) or contact the Medi-Cal Member Services Department by phone to request the change Department.