Submit Electronic Claims to Access
Health Net Access is working hard to make claims procedures easier for providers. Health Net Access' Electronic Data Interchange (EDI) solutions make it easy for more than 125,000 in our national provider network to submit claims electronically. Whether on-line, through your practice management system, vendor or direct through a data feed, EDI ensures that your claims get submitted quickly.
Instead of cumbersome paper forms and time consuming mailings, you can generally submit claims in just a few moments. With the click of a mouse or a keystroke, claims can be sent electronically. You can also submit via EDI any time, making it easier to attend to patient priorities. Health Net Access has contracted with Capario, Emdeon, and MD On-Line to provide claims clearinghouse services for Health Net Access claim submission.
For successful EDI claim submission, you'll need to use electronic reporting made available by your vendor and clearinghouse. View our approved vendor list and corresponding payer ID numbers below. Please reach out to your own vendor on connecting through one of these channels. Health Net Access returns claims acknowledgments back to the clearinghouse with notifications of acceptance or rejections of individual claims. Providers can review these reports to check the status of their submission.
Health Net Access processes anesthesia, medical, hospital and surgical claims electronically. We accept claims directly from MD On-Line, Capario, Emdeon and more. Claims regarding other benefits including certain mental health, complementary treatments, pharmacy, and outpatient radiology are administered for Health Net by outside vendors and claims should be submitted to each vendor accordingly.
If you're just starting out, we'll walk you through the process.
Learn More About EDI
Electronic Data Interchange (EDI) is the exchange of business transactions in a standardized format from one computer to another. Health Net Access and providers use this technology to communicate claims, electronic remittance, claims payment, eligibility and other information, providing a paperless and efficient process.
Quicker claims payment, confirmation reports and elimination of paper and associated expenses are just a few of the reasons why over80 percent of Health Net Access' claims are submitted electronically. A study* found that EDI claims processing reduces the average provider's cost per claim by $3.56. With hundreds or thousands of claims filed each year, savings add up – letting you focus more of your valuable resources on the things that really matter.
EDI also gives you the tools you need to track electronic claims status on-line, prove timely filing and access to daily accept/reject reports. This also means easier receivables and account reconciliation. By using Health Net Access-approved vendors and clearinghouses, HIPAA compliance is done for you and you'll have automatic access to highly secure and time-tested solutions.
Health Net Access has the following transactions available for providers through our approved clearinghouses: 837 electronic claim submission, 835 electronic remittance advice, real time eligibility (270/271) and real time claims status (276/277) transactions. We are CORE Phase II certified with our real time claims status and member eligibility transactions as well as compliant with the Federal Operating rules. EFT (electronic funds transfer) is also available with online registration via our website or downloadable forms to be sent via secure fax.
View our approved vendor list and corresponding payer ID numbers.
* Milliman Study. These results represent an analysis of typical provider practices and industry averages and many not apply to a specific practice or circumstance. They are not a guarantee of savings.
Electronic Claims Submission
Health Net Access contracts with Capario, Emdeon, and MD On-Line to provide claims clearinghouse services for Health Net Access electronic claim submission.
The benefits of electronic claim submission includes:
- Reduction and elimination of costs associated with printing and mailing paper claims
- Improvement of data integrity through the use of clearinghouse edits
- Faster receipt of claims by Health Net Access, resulting in reduced processing time and quicker payment
- Confirmation of receipt of claims by the clearinghouse
- Availability of reports when electronic claims are rejected and ability to track electronic claims, resulting in greater accountability
- HIPAA 835 electronic remittance files for download directly to a HIPAA-Compliant Practice Management for Patient Accounting System
For successful electronic data interchange (EDI) claim submission, participating providers must utilize the electronic reporting made available by their vendor or clearinghouse. There may be several levels of electronic reporting:
- Acceptance/rejection reports from EDI vendor
- Acceptance/rejection reports from EDI clearinghouse
- Acceptance/rejection reports from Health Net Access
Providers are encouraged to contact their vendor/clearinghouse to see how these reports can be accessed/viewed. All electronic claims that have been rejected must be corrected and resubmitted. Rejected claims may be resubmitted electronically.
Providers may also check the status of paper and electronic claims online at provider.healthnet.com.
All questions regarding electronic claims submission should be directed to Health Net Access Electronic Data Interchange (EDI) Department by telephone, 1-866-EDI-HNET (1-866-334-4638)
CORRECTED CLAIMS SUBMISSION
Clean claim submissions must be received no later than 12 months from the date of services or 12 months after the date of eligibility posting, whichever is later.
To resubmit a corrected EDI claim, the Claim Frequency code (3rd character in the bill type) in the 2300 loop CLM05-3 segment should be populated with a '7' to indicate replacement of previous claim. The original Health Net Access generated claim ID, if known, should be sent in the 2300 CLM loop with a REF segment with an F8 qualifier.
To resubmit on paper, corrected claims must be appropriately marked as such. For a UB04, the 3rd digit of the bill type in Box 4 should indicate a '7' as a replacement of previous claim. The Health Net Access generated claim ID in Box 65 labeled Payer Claim ID. For CMS1500 submission, the claim resubmission code in Box 22a should contain a '7' for replacement of previous of claim and the original Health Net Access generated claim ID should be sent in Box 22b labeled the Original Ref number.
Resubmitted paper claims must be sent to:
Health Net Access, Inc.
PO BOX 14095
Lexington, KY 40512
ELECTRONIC REMITTANCE ADVICE (ERA) AND ELECTRONIC FUNDS TRANSFER (EFT)
Health Net Access has further streamlined our business processes to improve claims procedures. Providers can now register to receive Electronic Remittance Advices (ERA). These features streamline claim processing, reduce administrative work and improve provider satisfaction by reducing claims-related problems.
ERA files give providers details regarding multiple claims. ERA improves providers' business office workflow by allowing the adjudicated claim information to be automatically posted to accounts receivable systems. Health Net Access will send an ERA to any provider who registers with Health Net Access and with a clearinghouse. ERA is available in all Health Net Access service areas.
Electronic Funds Transfer (EFT) automates the distribution of funds into providers' accounts using Automated Clearinghouse (ACH) processing. EFT is the electronic mechanism used to instruct Depository Financial Institutions (DFIs) to move money from one account to another. Many formats are available for the actual data in the electronic message, and different formats apply at each stage. EFT is safe, secure, efficient, and less expensive than paper check payments and collections.
- Visit PaySpan's website for more information: www.payspanhealth.com
Submit Claims Directly to Health Net Access (Through MD Online)
In partnership with MD On-Line, Health Net Access now gives providers the option of exclusively submitting Health Net Access claims for free through a private label Web site 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.
Submit Arizona Medicaid (AHCCCS) claims to:
Health Net Access of Arizona, Inc.
P.O Box 14730
Lexington, KY 40512
Tips and Terms
The following are some pointers on claims submissions, the HIPAA glossary of EDI terms and frequently asked questions (FAQ).
Here are some tips from our EDI specialists for successful claims submission:
- Health Net Access Member IDs begin with the letter "A" followed by eight numeric digits. IDs do not contain the letter "O", always use the numeric zero (0).
- Submit NPI information for the Rendering, Referring and Attending providers.
- Health Net Access processes Medical, Hospital, Anesthesia, Surgical and ER claims electronically from both participating and non-participating providers.
- Health Net Access encourages the electronic submission of all claims, however supporting documentation may be requested for the following types of claims through an Explanation of Benefits: COB, StopLoss, Trauma and Newborn NICU claims.
- Submit claims with the patient's name and birth date exactly as it appears on their Health Net Access ID card.
- Avoid timely filing issues through understanding and regular monitoring of EDI Reports. This process may help ensure all rejected claims are re-filed timely and electronically.
- Vendor/clearinghouse Initial Acceptance report may be submitted as proof of timely filing.
For Health Net ACCESS Members
Visit our members section for member information, including:
- Member Handbook
- Appeals & Grievances
- Pharmacy Information including drug lists, prior authorization and more.