26-1023 Notify Health Net of Ownership, Tax Identification Number and Provider Information Changes

Date: 08/26/26

Ancillary providers must promptly report information changes to help prevent claim denials and payment delays

You are required to notify Health Net in writing when changes occur that affect your provider records or contracting information.

Failure to notify us will result in claims being submitted under information that does not match our contracted provider records. Claims may be denied, processed as out of network or delayed until your records are updated.

Written notification is required for these changes

Under the terms of your Provider Participation Agreement (PPA), you must notify us in writing when any of the following changes occur:

• Change of ownership
• Tax Identification Number (TIN) change
• National Provider Identifier (NPI) change
• Business name change
• Address or location change
• Site addition
• Site closure
• Phone number change
• Other changes that affect provider records or contracting information

Where to send notifications

• Changes affecting your PPA
  • If you are undergoing a change of ownership, you must notify Health Net's Contracting Department and provide any required regulatory approval documentation as part of the change of ownership process. Send written notification by email.
• Changes not affecting your PPA
  • If the change is limited to your address, phone number or other demographic information, you must contact your Provider Engagement representative.
  • If you do not know who your Provider Engagement representative is, you must contact Community Health Plan of Imperial Valley at 833-236-4141.

Who this applies to

This requirement applies to ancillary providers. Ancillary providers include, but are not limited to:

• Ambulatory Surgery Centers (ASC)
• Birthing Centers
• Community Based Adult Services (CBAS)
• Community Health Worker (CHW) services
• Community Supports (CS)
• Dialysis facilities
• Doula services
• Durable Medical Equipment (DME) providers
• Enhanced Care Management (ECM)
• Family Planning facilities
• Hearing aid providers
• Home Health providers
• Home Infusion providers
• Hospice and Palliative Care programs
• Inpatient Rehabilitation facilities
• Intermediate Care Facilities (ICFs) and Long-Term Care facilities
• Laboratory facilities
• Long-Term Acute Care Hospitals (LTACHs)
• Orthotics and Prosthetics providers
• Ostomy and Medical Supply providers
• Radiology, Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), and Radiation facilities
• Skilled Nursing Facilities (SNFs) and Long-Term Care facilities
• Sleep Study centers

Need help? Contact us

If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141. Behavioral Health providers can call 844-966-0298.
 

This information applies to Ancillary Providers.

This information applies to Medi-Cal in Imperial County.