22-463 Respond to Requests for Itemized Bills to Ensure Timely Payment
Date: 06/10/22
This information applies to Hopsitals.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Avoid delays for hospital inpatient claims
Providers must send itemized bills supporting inpatient claims as instructed when they are notified by fax, phone or mail.
Pre-payment review
The Plan’s pre-payment review will ensure only correct billed charges, according to the Centers for Medicare & Medicaid Services Provider Reimbursement Manual, the Uniform Billing Editor guidelines and Revenue Code Definition requirements, are reimbursed. Plan policies will also be used in the review process.
These reviews will not be applicable where disallowed by provider contract.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center within 60 days, by phone or through the Health Net provider website as listed below.
Line of Business | Telephone Number | Provider Portal | Email Address |
EnhancedCare PPO (IFP) | 1-844-463-8188 | ||
EnhancedCare PPO (SBG) | 1-844-463-8188 | ||
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | ||
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | ||
Medicare (individual) | 1-800-929-9224 | ||
Medicare Advantage (HMO/PPO) (Wellcare By Health Net) | 1-800-929-9224 | ||
Medi-Cal | 1-800-675-6110 | N/A | |
Cal MediConnect – Los Angeles County | 1-855-464-3571 | N/A |