21-383m Reminder: Send Required Special Needs Discharge Data to Health Net

Date: 05/28/21

This information applies to Hospitals and Ancillary providers.

You must report full-risk, dual-eligible, special needs member admissions and discharge data

As a reminder, the process described below is a change in hospital and skilled nursing facility (SNF) procedure with respect to dual-eligible members assigned to full-risk participating provider groups (PPGs).

This change became effective March 1, 2021. In the past, hospitals and SNFs have primarily sent admissions/discharge/transfer (ADT) data only to PPGs. However, they must now also send it to Health Net.

What must you do?

Effective immediately, proactively send applicable ADT data to Health Net’s Hospital Notification Unit (HNU). If you do not do so, the HNU will contact you and request that you respond in a timely manner.

1. Submit the required data upon member admission/discharge to Health Net's HNU. Refer to the contact information below. The HNU will then enter the data into the TruCare^® system, from which it will be extracted for monthly report generation.
2. Contact the HNU per applicable policy. Hospitals must contact, via fax or by telephone as listed below, the HNU within 24 hours of an admission/discharge or one business day when an admission/discharge occurs on a weekend for a member. The HNU will reach out to providers, as needed, to request additional data.

HNU contact information

Line of business	Fax number	Provider portal website
Medicare	800-676-7969	Health Net provider website

For questions about hospital admissions, contact the Health Net HNU at 800-995-7890.

Refer to the list below for required data elements.

Required data

The Department of Health Care Services (DHCS) requires the following data on the monthly hospital or SNF report:

1. Last name.
2. First name.
3. Medicare beneficiary identifier (MBI).
4. Date of birth.
5. Client index number (CIN) – include if available.
6. Date of notification.
7. Date of admission.
8. Admitting facility – include if available.
9. Admitting cause or diagnosis – include if available; use ICD-10 codes separated by a semicolon.
10. Type of admission.
11. Care manager last name – include if available from provider.
12. Care manager first name – include if available from provider.
13. Care manager provider – include if available from provider.
14. Discharge date – include if available.
15. Discharge time – include if available.
16. Discharge disposition – include if available.
17. Discharging facility – include if available.
18. Discharge diagnosis – include if available; use ICD-10 codes separated by a semicolon.
19. Discharge instructions – include if available.

Background

DHCS policy requires dual-eligible special needs plans (D-SNPs) to share hospital and 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.

The DHCS requirements regarding coordination of care mandate that Health Net submit monthly reporting of D-SNP members' 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.

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	Email Address
Medicare	1-800-929-9224	provider_services@healthnet.com