23-409 New Durable Medical Equipment Billing Audit Program Ensures Correct Claims Payment

Date: 05/08/23

Send medical records to Performant if requested

Health Net* and Wellcare By Health Net (Health Net) periodically review and update policies and procedures for utilization management and claims payment. This helps provide the highest quality treatment and encourages appropriate utilization of resources.

Effective July 15, 2023, Health Net will implement a post-payment audit process for a select sample of durable medical equipment claims for Health Net members each month. To support this process, Health Net will be using an approved vendor, Performant, to complete these audits.

Performant will give written notice to providers who may have a claim selected for post-payment audit. Performant will request medical records to verify the claim was billed correctly and that the documentation supports the claim as required.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.