Claims Processing for DSNP in EAE Counties
Provider Type
- Participating Physician Groups (PPG)
Participating physician groups that are responsible for claims that are Medicare covered services must forward claims that have Medi-Cal covered services to Health Net within 10 business days for the Plan to process as a secondary claim. The secondary claim requires a copy of the Provider Explanation of Benefits (EOB) or Remittance Advice (RA) from the primary payer. Include the information that the claim was forwarded to the Plan in the EOB or RA. Do not deny the claim without checking both Medicare and Medi-Cal covered services. You can submit the secondary claim to the Plan following Standard Claims Submission requirements. You can also submit a paper claim to the Health Net Medi-Cal Claims Department or the Health Net Medicare Advantage Claims Department.