Health Net EDI

Health Net EDI (Frequently Asked Questions)

EDI claims submission has many options. Depending on the needs of your organization, there may be costs associated. Clearinghouses should be contacted directly so needs and options can be discussed.

CAN CLAIMS BE PAID FASTER IF I SUBMIT THEM ELECTRONICALLY?

Yes. Electronic claims are generally received in less time than those sent via the mail. Thus, processing time is often reduced.

ARE THERE COSTS ASSOCIATED WITH ELECTRONIC CLAIMS SUBMISSION THROUGH A CLEARINGHOUSE?

In partnership with MD On-Line, Health Net now gives providers the option of exclusively submitting Health Net claims for free through a private label website that links directly from www.healthnet.com. 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.

WHAT ARE THE ADVANTAGES OF SUBMITTING MY CLAIMS THROUGH A CLEARINGHOUSE?

Submitting through a clearinghouse has many advantages including:

  • It is not necessary to test with Health Net. Clearinghouses are HIPAA compliant.
  • Payer reports are submitted electronically through the clearinghouse vs. being sent via mail.
  • Clearinghouses will make available to providers the initial acceptance report confirming receipt of your claims by your clearinghouse and the payer. Payer Acceptance/Rejection reports can be used as proof of timely filing.
  • Initial Acceptance Report: This report shows your clearinghouse accepted the EDI claim and forwarded it to Health Net for additional payer editing and processing. Please note that claims can pass clearinghouse edits but still be rejected by Health Net.
  • Health Net Reject Report: This report shows that Health Net rejected the claim for “invalid subscriber ID number.” Please note that a claim that is filed and “rejected” is not considered “received” by Health Net. These claims should be corrected and resubmitted electronically as soon as possible to avoid timely filing issues.
  • Clearinghouses will notify providers of updates on changes in Health Net’s electronic claim submission policies.
To learn more about EDI and become a certified  EDI Professional please visit our course schedule page.

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