These retention requirements are based on Health Net's current Corporate Records Retention Schedule:Health Net must ensure maintenance of all records and documentation (including medical records) necessary to verify information and reports required by statute, regulation or contractual obligation for five years from the end of the fiscal year in which Health Net's contract expires or is terminated with a member.Standards for the administration of medical records by participating providers are established by the Health Net Quality Improvement Committee (HNQIC). In addition, medical records must reflect all aspects of member care, be readily available to health care providers and provide data for statistical and quality-of-care analysis. Medical records for primary care physicians (PCPs) may be selected for evaluation as part of the annual delegation oversight assessment.Health Net requires participating providers to have a written policy in place that provides for the protection of confidential protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Non-Contracting Provider Policies Information for Non-participating Providers: California The following policies and procedures apply to provider claims for services that are adjudicated by Health Net of California, Health Net Life Insurance Company, and Health Net Community Solutions "Health Net", except where otherwise noted. 1 Go to provider.healthnet.com. Provider Manual The Health Net Medicare Advantage (MA) Operations Manual offers Health Net providers access to important plan benefits, limitations and administration processes to make sure members enrolled in MA plans receive covered services when needed. Provider Manual California Correctional Health Care Services Formulary Claims and Provider Reimbursement Clinical Quality Management Compliance and Regulations Credentialing Dispute Resolution and Appeals Emergency Services Hospital Services Medical Parolees Medical Records Off-Site Medical Imaging Facilities Off-site Radiology Services On-Site and Mobile Medical Imaging On-Site … 3 After logging in, select Working with Health Net > Contractual > Services Requiring Prior Authorization. There will be no other fees charged to the health plan for this access. Prison Health Care Provider Network (PHCPN) participating providers who would like to deliver services onsite at a California Department of Corrections and Rehabilitation (CDCR) institution must complete California Correctional Health Care Services (CCHCS) credentialing requirements in addition to the Network Providers, LLC (NPLLC) credentialing process. However, access to records and audits that are part of a facility site review audit, grievance visit or potential quality issue (PQI) visit can be unannounced.When Health Net requests access to electronic medical records (EMR), the provider will grant the health plan access to the provider's EMR in order to effectively case manage members and capture medical record data for risk adjustment and quality reporting. There will be no other fees charged to the health plan for this access.The following applies to these counties: Fresno, Kings, Madera.Participating physician groups (PPGs), physicians, hospitals, and ancillary providers are required to provide Health Net and CalViva Health with copies of medical records and accounting and administrative books and records, as they pertain to the Provider Participation Agreement (PPA).The provider has financial responsibility to provide copies of medical records so that Health Net and CalViva Health can make claims and benefit determinations for utilization management, quality improvement, Healthcare Effectiveness Data and Information Set (HEDIS®), and appeals and grievance programs.Medical records may be required for regulatory reviews by the Centers for Medicare & Medicaid Services (CMS), Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), National Committee for Quality Assurance (NCQA), Independent Quality Review and Improvement Organization (QIO), and other regulatory bodies.Subject only to applicable state and federal confidentiality or privacy laws, the provider must share records when the health plan or its designated representative requests access to them, in order to audit, inspect, review, perform chart reviews, and duplicate such records.If performed onsite, access to records for the purpose of an audit must be scheduled at mutually agreed upon times, upon at least 30 business days prior written notice by the health plan or its designated representative, but not more than 60 days following such written notice.
Refer to the As a Health Net participating provider, you are required to comply with applicable Medicare laws and regulations and Health Net policies and procedures.The contents of Health Net's operations manuals are in addition to your PPA and its addendums. Health Net is a registered service mark of Health Net, LLC. The Health Net Medicare Advantage (MA) Operations Manual offers Health Net providers access to important plan benefits, limitations and administration processes to make sure members enrolled in MA plans receive covered services when needed.
Health Net is contracted with Medicare for HMO, HMO SNP and PPO plans, and with some state Medicaid programs.
The standards form the basis for the evaluation of medical records by Health Net.
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