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Medicare Electronic Claims Submission Guidelines

Date: 02/05/18

Health Net Oregon 18-108

Health Net Health Plan of Oregon, Inc. and Health Net Life Insurance Company (Health Net) continue to encourage electronic submission of Medicare Advantage (MA) and MA with Part D (MA-PD) claims via the 837 institutional and professional formats for faster processing. Claims submitted electronically require:

  • Both the appropriate member and payer identification (ID) numbers based on the line of business and date of service (DOS).
  • Institutional claims are limited to 97 service lines or less. Claims exceeding 97 service lines must be split by the submitter to avoid rejections.

Providers can refer to the information included in this communication when submitting electronic claims for processing.

REQUIRED MEMBER AND PAYER ID NUMBER INFORMATION

Refer to the table on page 2 for appropriate member and payer ID number information for electronic claims submissions based on line of business and DOS. Providers may also refer to the current member ID card for current member ID number and payer ID number information.

REJECTED CLAIMS

If providers have received a rejected claim indicating "The claim/encounter has invalid information and has been rejected", or "Subscriber/Member ID not found" (verbiage may differ based on clearing house selection), providers must resubmit the claim with the correct member ID number and corresponding payer ID number based on DOS. Refer to the table on page 2 for detailed information on member ID number and payer ID number information.

ADDITIONAL INFORMATION

For providers' reference, contact information for electronic claims submissions or electronic remittance advice (ERA) is included in the table on page 2.

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center through the Health Net provider website at provider.healthnetoregon.com, or by telephone at 1-888-445-8913.

If the line of business is: MA HMO, MA-PD HMO, MA PPO, MA-PD PPO
and the date of service is:then the member ID number must start with:and the payer ID number used must be:and the provider can submit claims on the provider portal listed below:
On or before December 31, 2017"R", as indicated on the member ID card in effect pre-201895567 provider.healthnet.com

On or after January 1, 2018

"R" or "C", as indicated on the member ID card, effective January 1, 201868069 provider.healthnetoregon.com


ELECTRONIC CLAIMS SUBMISSION AND ELECTRONIC REMITTANCE ADVICE CONTACT INFORMATION

Refer to the table below for contact information or inquiries on electronic claims submissions or ERA:

If the line of business is: MA HMO, MA-PD HMO, MA PPO, MA-PD PPO
and the date of service is:then use the following contact information:
On or before December 31, 2017Health Net EDI Department:
1-800-977-3568
or by email at edi.support@healthnet.com
On or after January 1, 2018 Centene EDI Department:
1-800-225-2573, extension 6075525,
or by email at: EDIBA@centene.com


THIS UPDATE APPLIES TO:

  • Physicians
  • Medical Groups/IPAs
  • Hospitals
  • Ancillary Providers

STATE:

  • Oregon
  • Washington

LINES OF BUSINESS:

  • Medicare Advantage (HMO/PPO)

PROVIDER SERVICES

www.healthnet.com
1-888-445-8913

NATIONAL PROVIDER COMMUNICATIONS

provider.communications@healthnet.com
Fax 1-800-937-6086