20-1034 Full-Risk, Dual-Eligible, Special Needs Member Admissions and Discharge Data Required for SNFs and Hospitals
Date: 12/29/20
This information applies to Hospitals and Skilled Nursing Facilities.
Starting March 1, send dual-eligible special needs member data to Health Net and PPGs
The Department of Health Care Services (DHCS) has developed a new policy that requires dual-eligible special needs plans (D-SNPs) to share hospital and skilled nursing facility (SNF) admissions data for all full dual-eligible enrollees with DHCS each month. DHCS will use this data to identify all dual-eligible member admissions to a hospital or SNF for any reason.
What are the requirements?
The DHCS requirements regarding coordination of care mandate that Health Net submit monthly reporting of D-SNP members' admissions/discharge/transfer (ADT) data for stays at participating hospitals and SNFs. In addition to the monthly reports at the member level, the DHCS requires Health Net to submit a semi-annual report at the aggregate level.
When does the change go into effect?
Beginning March 1, 2021, such institutional providers must submit the required data upon member admission/discharge to Health Net's Hospital Notification Unit (HNU). The HNU will then enter the data into the TruCare® system, from which it will be extracted for monthly report generation.
How does it affect me?
The process described above will be a change in hospital and SNF procedure with respect to dual-eligible members assigned to full risk PPGs. To date, hospitals and SNFs have primarily sent ADT data only to participating provider groups (PPGs). However, beginning March 1, 2021, they will also need to send it to Health Net.
Required data
The DHCS requires the following data to be included on the monthly hospital or SNF report:
- Last name.
- First name.
- Medicare beneficiary identifier (MBI).
- Date of birth.
- Client index number (CIN) – include if available.
- Date of notification.
- Date of admission.
- Admitting facility – include if available.
- Admitting cause or diagnosis – include if available; use ICD-10 codes separated by a semicolon.
- Type of admission.
- Care manager last name – include if available from provider.
- Care manager first name – include if available from provider.
- Care manager provider – include if available from provider.
- Discharge date – include if available.
- Discharge time – include if available.
- Discharge disposition – include if available.
- Discharging facility – include if available.
- Discharge diagnosis – include if available; use ICD-10 codes separated by a semicolon.
- Discharge instructions – include if available.
Who do I contact to report admissions?
Hospitals are required to contact, via fax or by telephone as listed below, the Health Net HNU within 24 hours of an admission or one business day when an admission occurs on a weekend for a member. The HNU will reach out to providers, as needed, to request additional data.
Contact information for the Health Net Hospital Notification Unit
Line of business | Fax number | Provider portal website |
|---|---|---|
Medicare | 1-800-676-7969 | Health Net provider website |
For questions about hospital admissions, contact the Health Net HNU at 1-800-995-7890.
Additional information
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
EnhancedCare PPO (IFP) | 1-844-463-8188 | ||
EnhancedCare PPO (SBG) | 1-844-463-8188 | provider_services@healthnet.com | |
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | provider_services@healthnet.com | |
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | provider_services@healthnet.com | |
Medicare (individual) | 1-800-929-9224 | provider_services@healthnet.com | |
Medicare (employer group) | 1-800-929-9224 | provider_services@healthnet.com | |
Medi-Cal | 1-800-675-6110 | N/A |