20-094 Required Advance Notice of Terminating Providers or Change in Practice Locations

Date: 01/21/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.

 

Ensuring members have access to care

The Department of Health Care Services (DHCS) requires Medi-Cal managed care plans (MCPs) to have a sufficient network of providers to ensure its members have timely access to care. MCPs also have prior notification requirements to members and to DHCS when there is a change in the location or availability of services in the MCP’s network, all subject to DHCS approval.    

As a reminder, all providers and delegated entities are required to give Health Net sufficient advance notice of terminations in their network panel of providers or of any service location terminations. The timeline required is outlined in your Provider Participation Agreement (PPA) and/or Health Net policies.

However, unless the stated effective date is further out, all such termination notices to Health Net for the Medi-Cal product will be made effective on the first of the month approximately 60 days from the end of the month of receipt by
Health Net (e.g., notice received January 10, termination will be effective April 1). Providers and delegated entities must ensure access for Medi-Cal members remains available during that time.

Per DHCS guidance, this prior notification requirement applies to all provider types, including, but not limited to, primary care physicians (PCPs), specialists, ancillaries, hospitals, clinics, and delegated entities; no exceptions. While Health Net will notify DHCS and members affected by PCP, clinic, medical group, or hospital changes, our delegated entities must ensure their affected members are properly notified when specialists they were receiving care from leave their network.

Additional information

Providers are encouraged to access the provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center within 60 days at 1-800-675-6110.