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Participating Provider Operations

The resources on this page contain useful self-service tools for participating providers to utilize when completing various operational tasks.

For Add to Group (ATG) requests:

  • Send email to Health Net Provider Data Coordination at DNPNM_DVP@healthnet.com
  • Email Subject: Medical/BH - ATG - Contract TIN - Practitioner NPI
  • Submit 1 email for each practitioner add request
  • Include the following documents as separate PDF documents, with the associated naming conventions
    (Note: one PDF with all documents will require resubmission):
    DocumentNaming ConventionExample filename
    Practitioner Add Form (PDF)​ATG_CONTRACT TIN_PRACTITIONER NPIATG_123456_9876543
    W-9​W9_CONTRACT TIN_PROVIDER GROUP NPI
    or
    W9_CONTRACT TIN_PRACTITIONER NPI    		W9_123456_9876543
    Medi-Cal Training Attestation (if applicable)​MCL_TRAIN_ATTEST_CONTRACT TIN_PRACTITIONER NPIMCL_TRAIN_ATTEST_123456_9876543
    DHCS Letter of Approval (if applicable)​DHCS_APPROVAL_CONTRACT TIN_PRACTITIONER NPIDHCS_APPROVAL_CONTRACT_123456_9876543
    License Renewal Copy (if license is due to expire within 3 months of submission)LICENSE_RENEWAL_CONTRACT TIN_PRACTITIONER NPILICENSE_RENEWAL_123456_9876543

  • Send email to Health Net Provider Data Coordination at DNPNM_DVP@healthnet.com
  • Email Subject: Medical/BH - RFG - Contract TIN - Practitioner NPI
  • Data Elements to include in body of email:
    • Name of practitioner(s)
    • Contracted TIN
    • Effective Date of termination
    • Impacted Address(es)

  • Send email to Health Net Provider Data Coordination at DNPNM_DVP@healthnet.com
  • Email Subject: Medical/BH - Demo - Contract TIN - Practitioner NPI
  • Data Elements to include in body of email:
    • Brief description of change request
    • Name of practitioner(s)
    • Contracted TIN
    • Effective Date of the change
    • Impacted Address(es)
    • New address if applicable
      • Required: Phone number
      • If applicable: Fax number, Medi-Cal information (office hours, Gender limitations, Age limitations)
    • Attach updated W9
      • Naming Convention
        • W9_CONTRACT TIN_PROVIDER GROUP NPI
        • W9_CONTRACT TIN_PRACTITIONER NPI
      • Example filename: W9_123456_9876543
Last Updated: 04/28/2025