21-235 Give Advance Notice for Provider Terminations or Practice Location Changes

Date: 03/25/21

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.

Ensure Medi-Cal members have access to care

All providers and delegated entities must give Health Net sufficient advance notice of provider terminations in their network panel or of any service location changes. The required timeline is outlined in your Provider Participation Agreement (PPA) and/or Health Net policies.

Termination timeline

Unless the stated effective date is further out, all 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.

Use any of these methods to submit prior notice

• Online: Complete the online form on the Health Net provider website under My Account > Profile > Update Provider Information. You must have Update Provider Information privileges to update and submit changes online.
• Call or email: Reach out to your provider relations & contracting specialist (PRCS) (formerly known as provider network administrator (PNA).

DHCS requirement

Per the Department of Health Care Services (DHCS), Medi-Cal managed care plans (MCPs) are required 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.

The prior notice requirement applies to all providers, including, but not limited to, primary care physicians (PCPs), specialists, ancillaries, hospitals, clinics and delegated entities; no exceptions. Health Net will notify DHCS and members affected by PCP, clinic, medical group, or hospital changes. Delegated entities must also properly notify their affected members when their specialists they were receiving care from leave the network.