The Medicare Advantage (MA) Provider Operations Manual covers the Dual Special Needs Plan as well.
The Wellcare By Health Net (Health Net) Operations Manual offers Health Net providers access to important plan benefits, limitations and administration processes to make sure members enrolled in MA plans receive covered services when needed. The Plan’s MA HMO plans are underwritten by Health Net of California, Inc. and Health Net Community Solutions, Inc (Health Net) and are regulated by the Centers for Medicare & Medicaid Services (CMS) and the California Department of Managed Health Care (DMHC).
Benefits and policies listed in the MA Operations Manuals apply to all Health Net MA plans unless specified otherwise in the Provider Participation Agreement (PPA), Schedule of Benefits or member's Evidence of Coverage (EOC).
The four providers types - Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary – are listed at the top of every page. Refer to the Provider Type listed at the top of the page to see if the content applies to you.
As a Plan participating provider, you are required to comply with applicable Medicare laws and regulations and Plan policies and procedures.
The contents of the Plan's operations manuals are in addition to your PPA and its addendums. When the contents of the Plan's operations manuals conflict with the PPA, the PPA takes precedence.