Overview

Under Health Net's Medi-Cal contracts, Health Net and its participating providers are prohibited from making any claim for recovery of the value of covered services rendered to a member when such recovery would result from an action involving the tort liability of a third party or recovery from the estates of deceased members or casualty liability insurance, including workers' compensation awards and uninsured motorist coverage.

Health Net and its participating providers are required to assist the Department of Health Care Services (DHCS) in pursuing the state's right to reimbursement from such recoveries. Health Net and its participating physician groups (PPGs) are required to notify DHCS within 10 days of the discovery of such cases. On request from DHCS for information, Health Net and PPGs must provide additional information within 30 days. Individual providers are obligated to assist Health Net and affiliated PPGs in providing the additional information on request.