22-159m Verify Member Eligibility with IVR Self-Service Tool
Date: 02/24/22
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.
Avoid hold time. Use our IVR system for fast and easy access to verify member eligibility, benefits, claim status and more
Health Net understands the need for participating providers to have access to verify a member’s active eligibility status. Providers may use our interactive voice response (IVR) self-service tool to verify the active eligibility status of our members. This update provides information on what to expect when providers use the IVR self-service tool to verify member eligibility.
How to access the IVR system
Our IVR phone system allows you to speak your responses or enter them using your phone keypad. The IVR will require you to confirm your identity prior to routing your call. To use the IVR system, call Provider Services at the phone number listed in the right-hand column or on page 2 of this update and follow the prompts:
- Enter your National Provider Identifier (NPI) and tax identification number (TIN) first.
- Enter or say member’s identification (ID) number. Press the numbers on your phone for the alpha character.
- Include member’s date of birth (dd/mm/yyyy) and zip code.
- Select option 3 for eligibility from the main menu.
- The IVR will respond based on the member’s current eligibility in one of the following ways:
- If the member is active , the IVR will say “<Member’s name> is active. The plan effective date for this patient is <active date>.” The active date will be 12/31/9999.
- If the member is cancelled, the IVR will say “<Member’s name> is cancelled. The plan effective date for this patient is <cancelled date>.”
- If the member is not an active user yet, the IVR will say “<Member’s name> is active. The plan effective date for this patient is <future effective date>”.
Additional information
Providers are encouraged to access Health Net’s provider portal 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 applicable Health Net Provider Services Center within 60 days at:
Line of business | Phone number |
|---|---|
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 800-641-7761 |
Cal MediConnect – Los Angeles County | 855-464-3571 |
Cal MediConnect – San Diego County | 855-464-3572 |
Medi-Cal | 800-675-6110 |