Skip to Main Content
HealthNet.com
Enter Keyword
Search
Provider Login
Line of Business
Medi-Cal
Medicare Advantage
EPO
HMO
HSP
PPO
Prison Health Care Provider Network
Provider Login
Line of Business
Medi-Cal
Medicare Advantage
EPO
HMO
HSP
PPO
Prison Health Care Provider Network
SEARCH
MENU
Go!
HealthNet.com
HSP
Provider Manual
Adverse Childhood Experiences (ACEs)
Benefits
Acupuncture
Alcohol and Drug Abuse
Allergy Treatment
Ambulance
Autism Spectrum Disorders
Bariatric Surgery
Behavioral Health
Blood
Chemotherapy
Chiropractic
Dental Services
Dialysis
Durable Medical Equipment
Essential Health Benefits
Family Planning
General Benefit Exclusions and Limitations
Genetic Testing
Hearing
Home Health Care
Hospice Care
Hospital and Skilled Nursing
Immunizations
Injectables
Maternity
Medical Social Services
Nuclear Medicine
Nurse Midwife
Outpatient Services
Periodic Health Evaluation
Preventive Services
Prosthesis
Rehabilitation Therapy
Support for Disabled Members
Surgery, Surgical Supplies, and Anesthesia
TMJ
Transgender Services
Transplants
Vision
X-Ray and Laboratory Services
Claims and Provider Reimbursement
Remittance Advice and Explanation of Payment System
Accessing Claims on the New Health Net Portal
Adjustments
Balance Billing
Billing and Submission
Capitated Claims Billing Information
Eligibility Guarantee
Emergency Claims Processing
Fee-For-Service Billing and Submission
Premium Payment Grace Period for Beneficiary Qualifying for APTC
Professional Claim Editing
Refunds
Reimbursement
Reinsurance
Schedule of Benefits and Summary of Benefits
Timely Filing Criteria
When Medicare is a Secondary Payer
Claims Coding Policies
Code Editing
Compliance and Regulations
Mandatory Data Sharing Agreement
Provider Offshore Subcontracting Attestation
Communicable Diseases Reporting
DMHC-Required Statement on Written Correspondence
Federal Lobbying Restrictions
Health Net Affiliates
Material Change Notification
Nondiscrimination
Coordination of Benefits
Overview
COB Payment Calculations
Disagreements with Other Insurers
Duplicate Plan Coverage
Medicare Plus (Plan J or HJA)
Order of Benefit Determination
Recovery of Excessive Payments
Services Instead of Cash Payments
The Plan's Right to Pay Others
TRICARE/CHAMPVA
Veterans' Administration
When the Plan is the Primary Carrier
When the Plan is the Secondary Carrier
Copayments
Calculation of Coinsurance
Collection of Copayments
Out-of-Pocket Maximum
Verify Copayments
Credentialing
Application Process
Denial Notification
Denial of Investigational or Experimental Treatment for a Terminal Illness
Notification Delays
Required Elements for Provider Notification Letters
Requirements for Notification of Utilization Management Decisions
Appeals, Grievances and Disputes
Member Appeals
Provider Appeals and Dispute Resolution
Grievances
Eligibility
Extension of Benefits
Provider Responsibility for Verifying Eligibility for On-Exchange IFP Members in Delinquent Premium Grace Period
Steps to Determine Eligibility
Emergency Services
Overview
Enrollment
Subscriber and Member Identification Numbers
Use of Social Security Numbers
ID Cards
Member ID Card
Medical Records
Confidentiality of Medical Records
Medical Record Documentation
Medical Record Forms and Aids
Member Rights and Responsibilities
Advance Directives
Member Rights and Responsibilities
Prescription Drug Program
Compounded Medications
Diabetic Supplies
Exclusions and Limitations
Generic Medications
Off-Label Medication Use
Participating Pharmacy
Physician Self-Treatment
Prescription Mail-Order Program
Prior Authorization Process
Quantity of Medication to Be Prescribed
Recommended Drug List
Prior Authorizations
How to Secure Prior Authorization on the Provider Portal
NIA - Prior Authorization
Prior Authorization Process for Direct Network Providers
Product Descriptions
PureCare HSP (Large Group)
Provider Oversight
Fraud, Waste and Abuse
Monitoring Provider Exclusions
Contractual Financial and Administrative Requirements
Facility and Physician Additions, Changes and Deletions
Service and Quality Requirements
Quality Improvement
Language Assistance Program and Cultural Competency
Quality Improvement Program
Referrals
Investigational and Experimental Treatment
Out-of-Network Providers
PureCare (Large Group) HSP Referral Process
Third-Party Liability
Coverage Explanation
Utilization Management
Care Management
Continuity of Care
Economic Profiling
Hospital and Inpatient Facility Discharge Planning
Medical Data Management System
Medical Management
Notification of Hospital Admissions
Separation of Medical Decisions and Financial Concerns
Utilization Management Goal
Behavioral Health Provider Operations Manual
Prior Authorization Requirements
Participating Physician Group (PPG) Performance Scorecard
Payment Policies
Updates and Letters
Forms and References
Education, Training and Other Materials
Health Equity, Cultural and Linguistic Resources
Contacts
Glossary
Quality Management Program and Resources
HSP
Select provider library topic from left navigation bar.
Last Updated: 05/03/2024
