Data Exchange Workflow

1. Health Net creates member identification file for county
2. Health Net loads file to sFTP site
3. Third-Party Entity performs member match
4. Third-Party Entity creates file as per Third-Party Entity to managed care plan file layout with Health Net member matches
5. Third-Party Entity loads file to sFTP site
6. Health Net loads file into internal systems
7. Health Net creates file as per managed care plan to Third-Party Entity file layout for members matched with Third-Party Entity
8. Health Net loads file to sFTP site
9. Third-Party Entity downloads files

Available Outbound Files for Third-Party Entities

• Demographic – Complete member demographic details, including date of birth, address, and phone numbers.
• Eligibility – Program names and current eligibility status for each member.
• Enrollment – Effective enrollment dates and associated site information.
• Open Referrals – Details on active clinical referrals, including related CPT codes.
• ECM/CS – Indicates whether a member is active with an Enhanced Care Management (ECM)/Community Supports (CS) provider, assigned provider details, and engagement status (e.g., Outreach, Enrolled, or Disenrolled).