Availability of Criteria

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Providers may obtain the criteria used to make a specific adverse determination by contacting the Medical Management Department. Providers have the opportunity to discuss any adverse decisions with the Health Net physician or other appropriate reviewer at the time of an adverse determination. The provider may also contact the medical director. A care manager may also coordinate communication between the medical director and the requesting provider.