20-317 Disease Management Transitioning from Optum to Health Net Integrated Care Management on March 15, 2020

Date: 04/01/20

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

Our patient-centered whole person care program can help you provide the best care and experience for your patients

Health Net* is updating providers that on April 30, 2020, our agreement with Optum^® for disease management for Cal MediConnect Plan (Medicare-Medicaid Plan) members will end.

Beginning March 15, 2020, Health Net will manage members with chronic conditions as part of the integrated care management program. Health Net Integrated Care Management is offered to all California Commercial and Medicare plan members assigned to a fee-for-service or shared risk provider group. Health Net is currently working with Optum to help transition members to the new program to avoid a gap in service.

The Integrated Care Management program supports and coordinates health care for members with complex physical, behavioral and psychosocial health issues, as well as members with chronic conditions, such as diabetes, asthma, congestive heart failure (CHF), or coronary artery disease (CAD). The program supports Health Net members, families and caregivers to help members achieve the best health, functional ability and quality of life through improved management of their disease or condition.

Referrals to Health Net Integrated Care Management

Providers may refer members by contacting Health Net Integrated Care Management at   1-888-732-2730. Providers may also complete the Care Management Referral Form available on provider.healthnet.com in the Provider Library under Forms and submit via fax or email as indicated on the referral form.

Additional information

Providers are encouraged to access Health Net’s 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 Provider Services Center by email at provider_services@healthnet.com within 60 days, by telephone or through the Health Net provider website as listed in the right-hand column.