24-170m Ask Members to Complete the Health Information Form So They Get Needed Services

Date: 02/09/24

Newly enrolled Medi-Cal members must complete the form within 90 days

As one of the first points of contact in your patient’s health care journey, your advice and recommendations as their primary care physician play a significant role in their choices and decisions concerning their health care.

New Health Net members are required to complete a Health Information Form within the first 90 days of enrollment. When you see members during their Initial Health Appointment, which is required within the first 120 days of enrollment, please remind them to complete the Health Information Form so we can provide the best services and resources to them.

How do members complete the form?

Members can find and complete the Health Information Form via either option below:

• New member welcome booklet – Members can find the form in the welcome booklet mailed to them along with a business reply envelope to return the completed form. The form is located in the second section.
• Medi-Cal only - Log on Health Net website – Members can log in to the member portal and access the Health Information Form under “Health Forms.”

Why should a member complete the form?

Completing and sending the form back to us helps us better understand the member’s needs so we can better provide services to and resources for them. It helps identify health barriers, extra needs and services, such as transportation, housing, access to food, impairments related to daily activities and independent living, and more.

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. Behavioral health providers can call 844-966-0298.

 

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

For Medi-Cal, this information applies to Amador, Los Angeles, Calaveras, Sacramento, Inyo, Mono, San Joaquin, Stanislaus, Tuolumne, and Tulare counties.