20-799 Change to Financial Responsibility for Diagnostic Testing
Date: 10/09/20
This information applies to Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Effective January 1, 2021, the DOFR will be updated
Diagnostic testing that is done in-home will follow the same Division of Financial Responsibility (DOFR) risk as diagnostic testing done in an outpatient facility. An example may include medically necessary home sleep tests for all members, including those who may be at risk for untreated sleep apnea. Conducting home sleep tests could provide safety for your patients at this time.
Participating physician groups (PPGs) that have Diagnostic Testing in an Outpatient Facility as their risk in the DOFR are financially responsible for diagnostic testing at home. This includes:
- Facility/Technical Component AND
- Professional Component
The DOFR will be updated with this change effective January 1, 2021.
Additional information
| Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
| Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | provider.healthnet.com | provider_services@healthnet.com |
| IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | provider.healthnetcalifornia.com | provider_services@healthnet.com |
| Medicare (individual) | 1-800-929-9224 | provider.healthnetcalifornia.com | provider_services@healthnet.com |
| Medicare (employer group) | 1-800-929-9224 | provider.healthnet.com | provider_services@healthnet.com |
| Medi-Cal | 1-800-675-6110 | provider.healthnet.com | N/A |