A provider dispute is defined as any verbal or written communication between a provider and Health Net that includes seeking to overturn a partial payment or payment denial decision.
A provider dispute is also defined as any written communication with Health Net (for example, written correspondence, email and fax) unless it clearly indicates the provider in appealing on behalf of the member. If so, it is handled as a member appeal.
Non-participating providers have 365 days to submit a dispute verbally or in writing with timelines beginning from the date of the Remittance Advice (RA). Providers can submit the dispute on the Provider Dispute Request Form (pdf), but that is not required. Providers can contact the Customer Contact Center at 1-888-802-7001(commercial) or 1-888-445-8913 (Medicare Advantage PPO) or submit the dispute in writing to:
Commercial Provider Disputes
Health Net Medicare – Appeals
Health Net responds to provider disputes within 30 calendar days of receipt and notifies providers if resolution requires more than 30 days. Notices of overturns of partial payment or payment denial disputes are via the RA notes on the adjusted claim. Uphold responses are written when the dispute is submitted in writing. Otherwise, Health Net responds to the dispute request verbally.
Non-participating providers for commercial products have no appeal opportunities unless appealing on behalf of the member. If a non-participating provider is dissatisfied with an outcome, the member has the right to appeal following Health Net's member grievance and appeal procedures.
To provide you with the most accurate plans and information in your area, we need to know your location. Please enter a ZIP code for Arizona, California, Oregon, or Washington.