Closure and Termination
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Participating physician groups (PPGs) are required to notify the Health Net Regional Provider Network Management Department in writing at least 90 days in advance of the date that a subcontracting provider does the following:
- closes the medical practice
- terminates the relationship with the PPG
For Medi-Cal plans, Health Net must notify Medi-Cal members in writing within 15 calendar days of receipt of a primary care physician (PCP) termination or changes in PCP locations or after any unforeseen provider changes have been reported to Health Net. The notice to Medi-Cal members must be approved by the Department of Health Care Services (DHCS) prior to release, and is sent by U.S. mail, with instructions on selecting a new PCP.
Health Net may allow a member to continue using a terminated provider when:
- A member had been receiving care for an acute or chronic condition, in which case care by the terminated provider is covered for 90 days or longer, if necessary, for a safe transfer of the member.
- A member is pregnant, in which case care by the terminated provider is covered until postpartum services related to the delivery are completed or longer, if necessary, for a safe transfer of the member.
The terminated provider is subject to the same contractual terms and conditions imposed prior to termination until medical care to the member is completed. These terms and conditions include, but are not limited to:
- credentialing
- hospital privileging
- utilization review
- peer review
- compensation
Refer to the Transition of Care topic for more information.
PPG, Physician and Hospital Termination
In order to comply with the provider termination regulations of the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC), participating hospitals, participating physician groups (PPGs) and physicians are required to notify Health Net's regional Provider Network Management Department, in writing, pursuant to the requirements of their Provider Participation Agreement (PPA).
Health Net offers transition of care assistance to members who request to complete a course of treatment of covered services by a terminated provider. Refer to the Transition of Care Assistance discussion under the Utilization Management topic.