Eligibility Verification Methods
Provider Type
- Physicians and Practitioners
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
When an individual seeks medical attention from a participating physician group (PPG), hospital or other provider, the provider must attempt to determine eligibility with Health Net before providing care.
Member eligibility is verified at the time that the identification (ID) card is issued; however, possession of the card does not guarantee eligibility. In cases where a member has lost an ID card or where eligibility may be in question, eligibility can be verified as follows:
Eligibility Reports (applies to capitated PPGs and hospitals). Refer to Use Eligibility Report to Verify Member Information in the Monthly Eligibility Reports section for more information.
- Online through one of the following provider portals:
- Health Net: Log in, select Eligibility at the top of the page, select Eligibility Check.
- Availity Essentials: Log in, go to the Patient Registration section, select Eligibility and Benefits
- Eligibility verification via the provider's clearinghouse. Health Net is a Phase I- and Phase II-certified entity with the Council for Affordable and Quality Healthcare (CAQH) Committee on Operating Rules (CORE) for eligibility responses. Providers must contact their vendor/clearinghouse to submit transactions via this method using an EDI transaction or clearinghouse product.
Contact the Health Net Provider Services Center for questions about Medicare Advantage members.
Note: The Health Net and Availity provider portals may not offer the same functions. Please refer to the Provider Access Guide: Availity and Health Net Provider Portals + Website for details on what functions can be accessed through each portal.
Refer to Behavioral Health Contact Information page for applicable information.