Claims and Billing
Health Net is committed to providing our participating providers with the best tools possible to support their administrative needs. Our electronic transactions capabilities will speed up the processing and payment of your claims.
Submitting Claims
Health Net Health Plan of Oregon, LLC (Health Net) is working hard to make claims procedures easier for providers. Health Net's Electronic Data Interchange (EDI) solutions make it easy for more than 125,000 in our national provider network to submit claims electronically. Whether online, through your practice management system, vendor or direct through a data feed, EDI ensures that your claims get submitted quickly.
PaySpan
Health Net and PaySpan are in partnership to provide an innovative web based solution for Electronic Funds Transfers (EFT’s) and Electronic Remittance Advices (ERA’s).
Secure Web Portal
Partial list of secure website functions include verify member eligibility, check/submit claims and submit/confirm authorizations.
EDI
Electronic Transactions (EDI) support for HIPAA transactions is provided for the health plan by Centene Corporation. Centene is currently receiving professional, institutional, and encounter transactions electronically, as well as generating an electronic remittance advice/explanation of payment (ERA/EOP). To conduct other HIPAA transactions not listed, please contact our EDI department at edi.support@healthnet.com.
Approved Vendors List
Health Net has contracted with Capario, Emdeon, and MD On-Line to provide claims clearinghouse services for Health Net claim submission. These partners will work with your clearinghouse or vendor to get the claims submitted to Health Net in a timely manner.
Benefits of electronic claim submission include:
- Reduction/elimination of costs associated with printing and mailing paper claims.
- Improvement of data integrity through the use of clearinghouse edits.
- Faster receipt of claims by Health Net, resulting in reduced processing time and quicker payment.
- Confirmation of receipt of claims by the clearinghouse.
- Availability of reports when electronic claims are accepted and rejected.
- Ability to track electronic claims, resulting in greater accountability.
| Clearinghouse | Telephone Number | Website | Health Net Payer ID |
|---|---|---|---|
| Capario (now Emdeon) | AZ, CA & OR 1-800-792-5256 | 95567 | |
| Emdeon | 1-877-469-3263 | 95567 | |
| MD On-Line* | 1-888-499-5465 | 95567 |
*As a result of our partnership with MD On-Line, all commercial payer claims can be submitted electronically via Health Net's legacy website, HealthNet.com. Medicare Advantage claims can be submitted via the new secure provider portal.
For successful EDI claim submission, providers/facilities must utilize the electronic reporting made available by their vendor/clearinghouse. There may be several levels of electronic reporting:
- Confirmation/rejection reports from EDI vendor
- Confirmation/rejection reports from EDI clearinghouse
- Confirmation/rejection reports from Health Net
Providers may also check the status of paper and electronic claims via our claims status transaction available through Emdeon or online at the appropriate portal. Registration is required.
Providers are encouraged to contact their vendor/clearinghouse to see how these reports can be accessed/viewed. All electronic claims that have been rejected must be corrected and resubmitted. Rejected claims may be resubmitted electronically.
For questions regarding electronic claim submission, please contact Health Net's dedicated EDI line:
California and Oregon: 1-800-977-3568