25-967m Guidelines and Restrictions for PCP Transfers Between Health Net and Molina

Date: 09/10/25

Retroactive transfers are discontinued effective immediately

The following updates outline important changes to the transfer process between Health Net and Molina, ensuring clarity and compliance with new requirements.

Key updates

• No retroactive transfers: Effective immediately, retroactive transfers are no longer permitted.
  • Exception: Retroactive transfers are allowed if requested by the Department of Health Care Services, or if both parties (Molina/Health Net) agree to the retroactive transfer only.
• Future effective dates only: All transfer requests will take effect on the first day of the following month.
• Hospitalization restriction: Members cannot transfer between Health Net and Molina while hospitalized.

Process for transfers

From Health Net to Molina –

1. Member action: Call Health Net Member Services at 800-675-6110 to request a transfer to Molina.

2. Health Net agent actions:

a. Confirm the member’s intent to transfer to Molina.

b. Process the primary care physician (PCP) changes to Molina with a future effective date (first of the following month).

c. Inform the member of the transfer to Molina.

d. Provide the Molina Member Services number at 888-665-4621 to the member.

e. Share member details and PCP assignment via the daily 834 member eligibility file sent to Molina.

From Molina to Health Net –

1. Member action: Call Molina Member Services at 888-665-4621 to request a transfer to Health Net.

2. Molina agent actions:

a. Confirm the member’s intent to transfer to Health Net.

b. Provide the Health Net Member Services number at 800-675-6110 and perform a warm transfer to ensure the member receives assistance.

3. Heath Net agent actions:

a. Process the PCP changes to Health Net with a future effective date (first of the following month).

b. Inform the member of the transfer to Health Net.

c. Terminate the member via the monthly 834 member eligibility file sent to Molina.

From a Molina PCP to a new Molina PCP

1. Member action: Call Health Net Member Services at 800-675-6110.

2. Health Net agent actions:

a. Confirm the member is with Molina.

b. Inform the member that they are assigned to Molina.

c. Provide the Molina Member Services number at 888-665-4621 and transfer the member. If a member has difficulties reaching Molina or connecting with an agent, perform a warm transfer to ensure the member receives assistance.

3. Molina agent action: Handle the PCP change internally.

Additional information

A relevant section of Health Net’s provider operations manual has been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.

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

 

This information applies to Physicians and Participating Physician Groups (PPGs).

For Medi-Cal, this information applies to Molina.