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HEALTH NET (formerly FIRST OPTION HEALTH PLAN)
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Quick Reference Guide |
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Telephone Guide |
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Claims Address |
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Health Net (This link is provided for the convenience of our website visitors. UMDNJ University Hospital takes no responsibility for the information or proprietary of the web sites listed above.) |
HEALTH NET QUICK REFERENCE GUIDE
Facility/Provider # Inpatient # IL5186 Outpatient # IL5187
ELECTIVE |
REQUIREMENTS |
INPATIENT ADMISSION |
Authorization Required 5 Days Prior to Admission by Admitting Physician or Hospital |
SAME DAY SURGERY |
Authorization Required by Admitting Physician or Hospital |
OUT PATIENT PROCEDURE |
Authorization Required by Admitting Physician or Hospital |
NOTE: Admitting Physician must call to obtain authorization @ 1-800-438-7886
(pre-certification). Hospital Admitting Department must call Health Net prior to admission or surgery to make admission or Surgery has been authorized.
NOTE: If HEALTHNET Is Secondary Carrier and HEALTHNET is not the Primary Insurance No Authorization or Pre-certification Is Required.
EMERGENCY ROOM VISIT |
PCP or Member must notify Health Net @ 1-800-438-7886 within 24-Hrs or next business day. Hospital must call to obtain authorization # within 24 hrs-or next business day. |
EMERGENCY ADMISSION |
24-hr or next day notification required by PCP or Hospital to obtain authorization #. |
DIRECT ADMISSION |
Authorization Required by PCP or Hospital |
MENTAL HEALTH/ADMISSION SUBSTANCE ABUSE |
See Note below |
NON EMERGENCY MENTAL HEALTH & SUBSTANCE ABUSE |
See Note below |
NOTE: For all Mental Health & Substance Abuse Admission, please contact Managed Health Network (MHN) @ 1-800-728-9899 prior to services.
NOTE: If HEALTHNET Is Secondary Carrier and HEALTHNET is not the Primary Insurance No Authorization or Pre-certification Is Required
Pre-Authorization Requirements
PRE AUTHORIZATION REQUIRED –OUTPATIENT |
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NOTE: Behavioral Health & Substance Abuse Must contact Managed Health Network prior to services.
NOTE: If HEALTHNET Is Secondary Carrier and HEALTHNET is not the Primary Insurance No Authorization or Pre- certification is Required.
HEALTH NET Senior Hospital / Ancillary Field Rep. Network Management |
732-353-7496 |
HEALTH NET Member Service Department |
1-800-562-4347 |
HEALTH NET Provider Service Department |
1-800-963-6286 |
HEALTH NET Pre-certification Department |
1-800-438-7886 |
CARECORE – Radiology Services Care Core Provider Services (NJ Providers) 8:30am-5:00 pmCare Core Prior Authorization (NJ Provider) 7:00am-6:00 pm |
1-866-469-8989 |
Home Care –Health Net |
1-8000-438-7886 |
Mental Health – Managed Health Network |
1-800-728-9888 |
Chiropractic Services (Landmark) |
1-800-638-4557 |
ALL DME – Durable Medical Equipment |
1-800-294-2275 |
Laboratory Services: QUEST Diagnostics |
1-800-631-1390 |
ACS/ Health Net
P.O. Box 14700
Lexington , KY 40512
COB CLAIMS
ACS/ Health Net
P. O. Box 14700
Lexington , KY 40512
CLAIM APPEALS
Care Core national
169 Myers Corners Road
Wappingers Falls , New York 12590
Attention: Claims Appeals
MENTAL HEALTH CLAIMS
Managed Health Network
5100 West Gold Leaf Circle Suite 300
Los Angeles , Ca 90056
SKILLED NURSING & SUB-ACUTE SERVICE CLAIMS
Coordinated Care Solution, Inc.
12301 Northwest 39 th Street
Coral Springs , FL 33065
CHIROPRATIC CLAIMS
Landmark Health Care
1750 Howe Avenue . Suite 300
Sacramento , CA 95825
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(all information subject to change without notice) |
Last Reviewed: October 2008
All contents copyright © 1997-8
UMDNJ. All rights reserved
All information within this site subject to change without notice.
University Hospital
150 Bergen Street
Newark, NJ 07103 USA
(973) 972 - 4300
