News
23-114 Receive Reimbursement for Business Expenses Related to Monkeypox Treatment
Date: 01/31/23
Providers can request reimbursement for Monkeypox testing, vaccinations, and therapeutics
As required by the Health and Safety Code section 1342.3 for the duration of the California State of Emergency regarding Monkeypox, Health Net* must cover the following services without cost sharing, prior authorization, or utilization management:
- Evidence-based items, services, or immunizations intended to prevent or mitigate Monkeypox as recommended by the U.S. Preventive Service Task Force (USPSTF) that have a rating of “A” or “B” or the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC).
- Health care services and products related to diagnostic and screening testing for Monkeypox that are approved or granted emergency use authorization by the Food and Drug Administration (FDA) or are recommended by the California Department of Public Health or the CDC.
- Therapeutics approved or granted emergency use authorization by the FDA.
Reimbursement for business expenses
Health Net is required to reimburse providers for business expenses incurred to prevent the spread of respiratory transmitted infectious disease for which a public health emergency has been declared. Reimbursement is as follows:
- Business expenses include personal protective equipment (PPE), additional supplies, materials, and clinical staff time over and above those expenses usually included in an office visit or other non-facility service or services.
- Providers are entitled to reimbursement for each individual patient encounter, limited to one encounter per day.
- Members must obtain Monkeypox immunizations and testing from in-network providers, but if unavailable Health Net will assist members access to services from out-of-network providers.
Filing claims
The deadline to file claims for providers impacted by members affected by monkeypox will be extended. Providers may contact the Provider Services Center for additional guidance on claims extension time frames at:
Line of business |
Phone number |
Email address |
|---|---|---|
EnhancedCare PPO (IFP & SBG) |
844-463-8188 |
|
Health Net Employer Group HMO, POS, HSP, PPO, & EPO |
800-641-7761 |
|
IFP (CommunityCare HMO, PPO, PureCare HSP, & PureCare One EPO) |
888-926-2164 |
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, by phone or through the Health Net provider website.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.