Timely Claims Submission
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Participating providers must submit claims within 120 calendar days after the date of service or as defined in the Provider Participation Agreement (PPA). Where Health Net is the secondary payer under coordination of benefits (COB), the 120-day period begins when the primary payer has paid or denied the claim.
When Health Net requests additional information regarding a claim, participating providers have 60 calendar days from the date of the request to submit the requested information. The remittance advice (RA) and explanation of payments (EOP) must be submitted with the requested information.
If a claim is not submitted within 60 calendar days, or the requested information is not returned to Health Net within 60 calendar days, the claim will be denied and the participating provider does not have the right to submit or resubmit the claim.