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Health Net addresses problems with explanation of payment

September 11, 2018
Area(s) of Interest: Commercial Payors Practice Management Payor Issues and Reimbursement 


On August 21, 2018, Health Net notified providers that some paper explanation of payment (EOPs), commonly known as explanations of benefits, for commercial exchange enrollees were not displaying amounts correctly. This problem prevented providers from properly reconciling the amount Health Net is responsible for or the patient cost-sharing.

 Health Net reports it has resolved all issues related to the misprinted EOPs, except in instances where the enrollee’s cost share may not be correctly displaying a figure that includes any coinsurance amount. Health Net advises that a fix for the cost share problem was implemented on August 31.

The IFP products affected include the Enhanced Care PPO, CommunityCare HMO, PPO, PureCare HSP and PureCare One EPO. Health Net reports that the EOP issues did not affect practices receiving electronic remittance advices via Payspan, only paper EOPs.

Physicians who were impacted by the misprinted EOPs can confirm payment details for claims processed, including the coinsurance amount, by downloading the claims detail report directly through the provider portal at provider.healthnetcalifornia.com.

Physicians with questions or who need further assistance, can contact the applicable Health Net Provider Services Center within 60 days at provider_services@healthnet.com,

  • EnhancedCare PPO (IFP) at (844) 463-8188
  • IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) at (888) 926-2164.

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