22-180 Help Members with Kidney Disease Have Better Health Outcomes

Date: 02/28/22

This information applies to Physicians and 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.

Expect communications from Somatus, Inc., a specialty kidney care vendor

Health Net and Wellcare By Health Net have partnered with Somatus, Inc. to offer an integrated care management program for members with chronic kidney disease (CKD) or end-stage renal disease (ESRD). The program will begin in 2022 and expand to other lines of business by the end of the year.

How this affects you

We are previewing this care coordination initiative with you because some of your renal patients may qualify for and benefit from our program.

The opt-in Kidney Care Coordination Program will enable us to better partner with you to facilitate the care of CKD and ESRD patients. Our goal is to provide a more integrated experience for members and achieve better outcomes.

Upcoming notices

You will receive advance notice of the go-live date prior to the start of the member program. Also, Somatus will reach out directly to members and providers with information that will explain the details of the program.

Program details

In general, our kidney care program will provide:

• Care management to help patients manage their kidney disease and comorbidities.
• Education to provide better understanding of kidney diagnoses as well as treatment and dietary options.
• Guidance as patients explore dialysis and transplant options, if appropriate.
• Help to safely transition new dialysis patients from hospital to home.
• Help from social workers, who are available to help with food and other social determinants that limit compliance.

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
Medicare (Individual & Employer Group)	800-929-9224
Cal MediConnect – Los Angeles County	855-464-3571
Cal MediConnect – San Diego County	855-464-3572
Medi-Cal	800-675-6110