23-1510 Starting January 1, 2024, Submit Claims to Health Net for Secondary Payment with a Copy of the Medicare EOB for Dual Eligible Members

Date: 12/28/23

Read on to learn how this change impacts secondary claims payments for members who are dually eligible for Medi-Cal and Medicare

As a reminder, effective January 1, 2024, your provider contract with Health Net Community Solutions, Inc. (Health Net) will replace California Health & Wellness Plan (CHWP). You will provide services to Medi-Cal members in Imperial County through Health Net’s provider network on behalf of Community Health Plan of Imperial Valley.

Starting January 1, 2024, and until further notice, providers in Imperial County are required to submit secondary Medicare claims directly to Health Net for payment. These claims can be submitted either electronically or by paper and must include a copy of the Medicare Explanation of Benefits (EOB). Please send secondary paper claim submissions to the following address:

Health Net Community Solutions, Inc.
Medi-Cal Claims
PO Box 9020
Farmington, MO 63640-9020
Payer ID: 95567

We are currently enhancing our system to accept automatic submissions of secondary claims from the Centers for Medicare & Medicaid Services (CMS). Once we can accept these automatic claims, we will provide further instructions.

Additional information

If you have questions regarding the information in this update, contact the Health Net Medi-Cal Provider Services Center at 800-675-6110.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

This information applies to Medi-Cal in Imperial county.