Claims Denials
Provider Type
- Participating Physician Groups (PPG)
- Hospitals
The Delegation Oversight auditors review claim denial by delegated entities to ensure that notification letters to providers comply with accuracy and timeliness requirements. Providers may not send a denial notice to a member as they are provider denials only..
Claim Audit Check Cashing Requirement
Health Net conducts audits to ensure 70% of checks mailed by the delegated entity to their participating and non-participating providers are cleared within 14 calendar days from the date the check was mailed. Check mailing is monitored to validate that checks are being mailed timely.