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
PPO
Provider Manual
Adverse Childhood Experiences (ACEs)
Benefits
Acupuncture
Alcohol and Drug Abuse
Allergy Treatment
Ambulance
Autism Spectrum Disorders
Bariatric Surgery
Behavioral Health
Blood
Clinical Trials
Cosmetic and Reconstructive Surgery
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
Incarcerated Members
Maternity
Medical Social Services
Nuclear Medicine
Nurse Midwife
Obesity
Outpatient Services
Periodic Health Evaluations
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
Fee-For-Service Billing and Submission
PPO Billing
Premium Payment Grace Period for Beneficiary Qualifying for APTC
Professional Claim Editing
Refunds
Reimbursement
Salud con Health Net
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
Reproductive Privacy Act
Provider Offshore Subcontracting Attestation
Communicable Diseases Reporting
Federal Lobbying Restrictions
Health Net Affiliates
Material Change Notification
Nondiscrimination
Coordination of Benefits
Overview
COB Payment Calculations
Disagreements with Other Insurers
The Plan's Right to Pay Others
When the Plan is the Primary Carrier
When the Plan is the Secondary Carrier
Copayments
Calculation of Coinsurance
Out-of-Pocket Maximum
Verify Copayments
Credentialing
Application Process
State Requirement for Providing Behavioral Health Services
Denial Notification
Service Denial Templates
Member Denial Letter Templates
Required Elements for Member Notification Letters
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
COBRA Continuation
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
Encounters
Lien Recoveries
Enrollment
Dependent Documentation Provided to Non-Subscriber
Subscriber and Member Identification Numbers
Use of Social Security Numbers
Late Enrollment Rules Waived
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
Coverage Explanation
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
Fax Requests
How to Secure Prior Authorization on the Provider Portal
NIA - Prior Authorization
PPO Services Requiring Prior Authorization
Prior Authorization Process
TurningPoint
Peer-to-Peer Review Requests
Product Descriptions
Point of Service (POS) Product
Elect Open Access Two Tier Plan
Elect Two Tier Plan
Ambetter PPO
Health Savings Accounts (HSAs)
Leased PPO Benefit Program
PPO Product
Select Three Tier Plan
Select Two Tier Plan
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
Disease Management Programs
Health Education Program
Health Management Programs
Language Assistance Program and Cultural Competency
Quality Improvement Program
Referrals
Overview
Investigational and Experimental Treatment
Lab and X-Ray Referrals
Third-Party Liability
Coverage Explanation
Utilization Management
Overview
Care Management
Clinical Criteria for Medical Management Decision Making
Continuity of Care
Economic Profiling
Hospital and Inpatient Facility Discharge Planning
Medical Data Management System
Non-Delegated Medical Management
Notification of Hospital Admissions
Utilization Management Goal
Appeals, Grievances and Disputes
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
Provider Pulse Newsletter
Contacts in Alphabetical Order
Glossary
Quality Management Program and Resources
Provider Manual Archive
PPO
Select provider library topic from left navigation bar.
Last Updated: 04/24/2024
