Health Net EDI

Health Net EDI Provider Claims Submission And EDI Exchange

Health Net EDI technology is used to communicate claims, electronic remittance, claims payment, eligibility, and other information, providing a paperless and efficient process.

Quicker claims payment, confirmation reports, and elimination of paper and associated expenses are just a few of the reasons why nearly 80 percent of Health Net’s claims are submitted electronically. EDI also gives you the tools you need to track electronic claims status, improve timely filing, and access daily accept/reject reports. This also means easier receivables and account reconciliation. By using Health Net-approved vendors and clearinghouses, HIPAA compliance is done for you, and you’ll have automatic access to highly secure and time-tested solutions.

Health Net has the following transactions available for providers through one of the approved clearinghouses: 837 electronic claim submission, 835 electronic remittance advice, and EFT payments. Health Net is CORE Phase III certified with real-time claims status and member eligibility transactions as well as compliant with the federal operating rules.

Submit EDI claims through a clearinghouse

For successful EDI claim submission, you’ll need to use electronic reporting made available by your vendor and/or clearinghouse. Health Net returns claims acknowledgements back to the clearinghouse with notifications of acceptance or rejections of individual claims. Providers can review these reports to check the status of their submission.

Health Net processes anesthesia, medical, coordination of benefits (COB), hospital, and surgical claims electronically. We accept claims directly from Change Healthcare, MD-OnLine/Ability, Availity and more. Claims regarding other benefits, including certain mental health, complementary treatments, pharmacy, and outpatient radiology are administered for Health Net by outside vendors and claims are processed by each vendor accordingly.

Submit claims directly to Health Net (through MD Online)

In partnership with MD On-Line/Ability Network, Health Net now gives providers the option of exclusively submitting Health Net claims for free through a private label website that links directly from The two products offered on the site allow providers to submit claims using either their own practice management software or direct data entry. The latter allows smaller practices to take advantage of the benefits of submitting claims electronically without having to bear the expense of specialized software. Providers may also use MD On-Line’s services as an all payer solution for which standard MD On-Line fees apply.

To learn more about EDI and become a certified  EDI Professional please visit our course schedule page.

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