New Provider Welcome Packet for Commercial/Marketplace Products

The materials here and the trainings available online supplement the health plan's operations manuals to assist you in understanding and adhering to policies and procedures in accordance with your Provider Participation Agreement (PPA). In-person training is also available. Providers who would prefer in-person training may contact Provider Relations by email to request a training session. This packet includes provider education materials to help you and your staff become familiar with the health plan's line of business/product. This packet includes the following materials:

• Who We Are and What We Do (PDF)
• Claims Processing (PDF)
• Prior Authorization (PDF)
• Referrals (PDF)
• Case Management (PDF)
• Provider Appeals (PDF)
• Member Grievance (PDF)
• Adding or Removing Members (PDF)
• Emergency Services (PDF)
• Pharmacy (PDF)
• Additional Benefits (PDF)
• Provider Portal Guide (PDF)
• Website Details (PDF)
• Cultural Sensitivity (PDF)
• Evidence-based Practice Guidelines (PDF)
• Health Net Provider Services Center (PDF)
• Eligibility Verification (PDF)
• Payspan Health (PDF)
• Member Rights & Responsibilities (PDF)