9. How does Health Net’s provider network in the Northeast compare with the UnitedHealthcare network in the Northeast?
The majority of Health Net’s participating provider network in the Northeast, approximately 95 percent of Health Net’s participating commercial physicians, hospitals and other health care professionals, participate in UnitedHealthcare’s network. As always, UnitedHealthcare welcomes health care professionals who are not participating with UnitedHealthcare to join the UnitedHealthcare network by initiating the standard credentialing process.
For those who are not currently participating with UnitedHealthcare and wish to join the network, contact UnitedHealthcare and its affiliates at (877) 842-3210, enter your tax ID, select option 5, then option 1, and you will be transferred to a credentialing specialist.
10. How will outstanding Health Net claims in the Northeast be paid after the transaction closes?
Health Net will process all claims for Health Net members in accordance with the terms of the member’s benefit and provider’s contract.
11. Should I continue to work with my Health Net provider relations representative in the Northeast?
Yes, you should continue to work with your Health Net representative until time of renewal.
Health Net will be responsible for all other administrative services, including claims payment, appeals and grievances, recredentialing, appeals and grievances, provider relations, and prior authorizations for the services provided during the period of time a member remains covered by Health Net.
You should work with UnitedHealthcare for contracting and contract renewals; a UnitedHealthcare representative will reach out to you when that time arises.
12. If a member has received prior authorization for a service to be performed past the transition date, will this service continue to be approved through the UnitedHealthcare plan?
In most cases, the preauthorizations issued by Health Net will be accepted by UnitedHealthcare. However, there may be some unusual instances where Health Net approved a service that is excluded in the UnitedHealthcare and/or Oxford product coverage certificates. UnitedHealthcare would evaluate these on a case-by-case basis, but without that evaluation, there cannot be a guarantee of coverage, unless such coverage is otherwise required by applicable law.