Health Net for Behavioral Health Providers

• HN
• Regional Commercial

Health Net

Health Net of California, Inc.

Health Net is Centene's California-based commercial and Medicare Advantage plan, covering millions of members across commercial, MediCal, and MA lines.

Quick Reference

Payer Type

Regional Commercial

Parent Company

Centene Corporation

Headquarters

Woodland Hills, CA

BH Division

Health Net Behavioral Health

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

CAQH ProView

Timeline

60-120 days

Coverage

1 states

Last Verified

Apr 19, 2026

Published

Apr 19, 2026

Reading Time

10 min

Covered Levels of Care

• Medically Managed Detoxification
• Residential Treatment
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Outpatient Treatment
• Medication-Assisted Treatment (MAT)

Medical Necessity Criteria

• ASAM Criteria (for substance use disorders)
• Health Net Clinical Coverage Criteria (proprietary mental health guidelines)

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Overview

Health Net of California is a regional managed care organization headquartered in Woodland Hills, California, and one of the state’s largest health insurers. Health Net became a wholly owned subsidiary of Centene Corporation in March 2016. Despite its corporate parent being a national Medicaid and managed care giant, Health Net continues to operate as a distinct California-focused brand, offering commercial employer-sponsored plans, individual and family plans, MediCal managed care (California’s Medicaid program), and Medicare Advantage plans for seniors.

Health Net serves millions of California members across its commercial, MediCal, and Medicare Advantage lines of business. Its commercial plans serve employer groups throughout the state, particularly in Northern and Southern California. Its MediCal plans are administered under contracts with the California Department of Health Care Services (DHCS) and cover Medicaid-eligible members in a number of California counties. The Medicare Advantage line, marketed as Health Net Senior products, provides coverage to California seniors with plan designs that often include enhanced behavioral health benefits compared to Original Medicare.

For behavioral health providers in California, Health Net is a significant payer across all service lines. The behavioral health landscape with Health Net is shaped by California’s robust state mental health parity laws, including SB 855 (effective January 1, 2022), which strengthened parity requirements and specifically required insurers to use recognized level-of-care criteria such as the ASAM Criteria for substance use disorder treatment, rather than less favorable proprietary criteria. Treatment centers should be well-versed in both federal parity law and California-specific parity requirements when working with Health Net.

Behavioral Health Coverage

Health Net covers behavioral health services across the levels of care most relevant to treatment centers, including medically managed detoxification, residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), standard outpatient treatment, and medication-assisted treatment (MAT). The specific benefits available to any individual member depend on which Health Net line of business they are enrolled in — commercial, MediCal, or Medicare Advantage — and, for commercial members, the specific benefit design of their employer’s plan.

For medical necessity determinations, Health Net uses the ASAM Criteria as the primary framework for substance use disorder level-of-care decisions, consistent with California’s SB 855 requirements for commercial and MediCal managed care plans. For mental health services, Health Net applies its proprietary Clinical Coverage Criteria, which define symptom severity, functional impairment, and risk thresholds required at each level of care. Treatment centers should review Health Net’s current clinical guidelines, available through the provider portal, to understand the specific documentation requirements for each level of care.

MediCal behavioral health coverage through Health Net is governed by California DHCS, which sets minimum benefit requirements and covered services. Mental health services above a certain acuity level — commonly referred to as specialty mental health services — may be carved out to county Mental Health Plans (MHPs) rather than administered by Health Net, depending on the member’s county of enrollment. Substance use disorder treatment services may be covered under the Drug Medi-Cal Organized Delivery System (DMC-ODS) in participating counties. Providers working with Health Net MediCal members should verify whether behavioral health benefits are administered by Health Net or by the county MHP to determine the correct authorization and billing pathway.

Medicare Advantage behavioral health benefits follow the CMS framework, with Health Net required to cover outpatient mental health and substance use disorder treatment at parity with Original Medicare Part B and inpatient psychiatric care consistent with Medicare inpatient rules. Health Net’s MA plan designs may offer supplemental benefits or lower cost-sharing than Original Medicare for certain behavioral health services.

Credentialing and Provider Enrollment

Health Net uses CAQH ProView as the foundation of its credentialing process for behavioral health providers and facilities. Before initiating enrollment, ensure your CAQH ProView profile is fully attested and up to date, with current information on licensure, accreditation, malpractice insurance, NPI numbers, taxonomy codes, and service locations. You can then initiate a provider enrollment application through the Health Net provider portal at provider.healthnet.com ↗ or by contacting Health Net provider relations.

The credentialing timeline for Health Net typically runs approximately 60 to 120 days from submission of a complete application, though timelines can vary based on application completeness, volume, and line of business. Commercial credentialing and MediCal credentialing may be processed through different pathways, and credentialing for one line of business does not automatically extend to others. Verify which lines of business you are enrolled in after credentialing is complete.

For behavioral health facilities in California, commonly required credentialing documents include: current California DHCS facility license (or applicable state license for your service type), program certification for substance use disorder programs (DHCS or CCAPP as applicable), Joint Commission or CARF accreditation, organizational NPI and taxonomy codes, federal tax ID and W-9, professional liability insurance certificates, and a program description with your service offerings and clinical staffing. Individual clinical staff licenses and DEA registrations for prescribing clinicians are required for staff credentialing under the facility contract.

Health Net may conduct site visits as part of facility credentialing, particularly for residential treatment centers, detoxification programs, and PHP facilities. Be prepared to demonstrate compliance with California DHCS licensure standards, your accreditation standards, and Health Net’s own facility requirements. Recredentialing generally occurs on a three-year cycle. Maintain your CAQH ProView attestation every 120 days and promptly notify Health Net of material changes to your facility, licensure, or clinical leadership.

Verification of Benefits (VOB)

Benefits verification for Health Net members can be performed through the Health Net provider portal at provider.healthnet.com ↗, by calling the provider services number on the member’s insurance card, or through electronic EDI 270/271 eligibility transactions via your clearinghouse.

When verifying benefits for a Health Net member, confirm the following: the specific Health Net line of business (commercial, MediCal, or Medicare Advantage); active coverage status and effective and termination dates; whether behavioral health benefits are administered by Health Net directly or carved out to a county Mental Health Plan or other entity; covered levels of care for both mental health and substance use disorders; deductible amounts and year-to-date accumulations; coinsurance, copay, or cost-sharing requirements for each level of care; out-of-pocket maximum and current status; any day, visit, or dollar limitations; authorization requirements by level of care; and whether the member has any out-of-network benefits.

Health Net commercial plan designs vary significantly across employers. Some plans include comprehensive residential behavioral health benefits while others may have limitations. For MediCal members, the scope of behavioral health benefits depends on California DHCS requirements and the specific county carve-out structure. Never extrapolate from one Health Net patient to the next — verify benefits individually for every admission and document the verification thoroughly, including the date, time, reference number, and name of the representative.

Prior Authorization Requirements

Health Net generally requires prior authorization for residential treatment, medically managed detoxification, and partial hospitalization programs across its commercial and Medicare Advantage lines. Authorization requirements for intensive outpatient and standard outpatient services vary by plan design, with some commercial plans requiring notification or authorization for IOP while others do not.

Prior authorization can be submitted through the Health Net provider portal, by phone, or by fax. Clinical documentation submitted in support of a prior authorization request should include a current clinical assessment, DSM-5 diagnoses, the recommended level of care with clinical justification addressing ASAM Criteria dimensions for substance use disorders, a proposed treatment plan with measurable goals, previous treatment history, current medications, and risk assessment information.

For MediCal behavioral health services, authorization requirements depend on whether the service is administered by Health Net or carved out to the county Mental Health Plan or DMC-ODS. Services carved out to the county are authorized through county-specific processes, not through Health Net. For Health Net-administered MediCal behavioral health, obtain authorization through the Health Net provider portal or by contacting Health Net MediCal provider services.

Concurrent review is required for residential and inpatient stays. Reviews are generally conducted every 5 to 7 days for residential treatment and every 7 to 14 days for PHP, though intervals can vary by plan type and clinical circumstances. Each concurrent review requires updated clinical documentation demonstrating ongoing medical necessity, treatment progress, and active discharge planning.

If an authorization request is denied, you have the right to request a peer-to-peer review with a Health Net medical director, particularly for clinically complex cases. Document all peer-to-peer conversations carefully. For MediCal members, California law provides specific grievance and appeal rights that may differ from commercial plan appeal procedures.

Claims and Billing

Health Net accepts claims via electronic submission and paper submission. Electronic claims should be submitted in 837I (institutional) or 837P (professional) format through your clearinghouse. Paper claims use the UB-04 form for institutional claims and CMS-1500 for professional claims. Health Net has multiple payer IDs across its commercial, MediCal, and Medicare Advantage lines — confirm the correct payer ID with your clearinghouse for each specific plan type to avoid claims routing errors.

Timely filing requirements vary by line of business. Commercial plans generally require claims submission within 180 days from the date of service for participating providers, though your specific provider agreement may specify a different timeframe. MediCal managed care claims generally must be submitted within 180 days of the date of service, consistent with California DHCS billing guidelines, with exceptions for coordination of benefits situations. Medicare Advantage claims for non-contracted providers must be submitted within one calendar year from the date of service per CMS requirements; contracted providers should follow the specific contract terms.

Common denial reasons for behavioral health claims with Health Net include lack of prior authorization, medical necessity documentation insufficient, timely filing exceeded, incorrect payer ID (claims routed to wrong line of business), coordination of benefits issues, and services rendered by non-credentialed providers. For MediCal claims, additional denial reasons may include billing a service that is carved out to the county rather than covered by Health Net.

Health Net’s appeal process for commercial plans generally includes two levels of internal appeal, with first-level appeal deadlines typically within 180 days of the adverse benefit determination, though timeframes may vary by plan and state. For MediCal managed care denials, California’s Medi-Cal managed care grievance and appeals rules apply, including the right to an independent medical review under California law. For Medicare Advantage denials, the five-level CMS appeals pathway applies.

Key Contact Information

• Provider Portal: provider.healthnet.com ↗ — Health Net’s primary provider transaction platform for eligibility, authorization, and claims
• Credentialing: CAQH ProView ( proview.caqh.org ↗ ) for credentialing data; initiate enrollment through the Health Net provider portal
• Prior Authorization: Submit through the Health Net provider portal or contact Health Net Behavioral Health at the number on the member’s insurance card
• Verification of Benefits: Health Net provider portal for electronic verification; call the provider services number on the member’s insurance card
• Claims Submission: Electronic via clearinghouse — confirm the correct Health Net payer ID for the specific line of business (commercial, MediCal, or Medicare Advantage) with your clearinghouse before submitting
• Claims Mailing Address: Varies by plan and line of business; refer to the member’s insurance card or the provider portal for the correct address
• MediCal Provider Services: Contact Health Net MediCal provider services for county carve-out questions and Medi-Cal-specific authorization guidance
• Clinical Coverage Criteria: Available through the Health Net provider portal under clinical resources

Frequently Asked Questions

Health Net offers three major lines of business in California: commercial fully insured and self-funded employer plans, MediCal (California Medicaid) managed care, and Medicare Advantage (Senior plans). Behavioral health benefits and authorization workflows differ meaningfully across these lines. Commercial plans generally follow Health Net's standard Clinical Coverage Criteria; MediCal plans are subject to California DHCS rules and may have distinct covered services and timely filing requirements; and Medicare Advantage plans follow CMS frameworks. Always identify which line of business applies to a given member before initiating authorization or billing, and verify whether behavioral health is administered directly by Health Net or managed through a separate carve-out arrangement. Contact [Health Net's provider portal](https://provider.healthnet.com) for plan-specific requirements.

Health Net became a wholly owned subsidiary of Centene Corporation in March 2016. Operationally, Health Net continues to function as a distinct regional brand in California, with its own provider portal, network, and credentialing processes separate from Centene's national brands such as WellCare and Ambetter. Your Health Net provider agreement and network participation are specific to Health Net of California — being contracted with Health Net does not automatically extend to other Centene subsidiary plans, and vice versa. That said, some back-office functions and clinical guidelines have gradually aligned with Centene standards. If you are credentialed with other Centene plans in different states, confirm whether a separate Health Net credentialing application is still required with Health Net's provider enrollment team at [provider.healthnet.com](https://provider.healthnet.com).

Health Net credentialing for behavioral health facilities generally uses CAQH ProView as the data source. Ensure your CAQH profile is complete, fully attested, and current before initiating enrollment. Commonly required documents include current California facility licensure (DHCS or Department of Public Health as applicable), state-recognized program certification for substance use disorder programs, professional liability insurance, accreditation from Joint Commission or CARF, organizational NPI, W-9, and a program description. Individual clinical staff licenses and DEA registrations for prescribers are required at the individual clinician level. The credentialing timeline typically runs approximately 60 to 120 days, though timelines vary based on application completeness and volume. Initiate credentialing through [provider.healthnet.com](https://provider.healthnet.com) or contact Health Net provider relations for current requirements.

Health Net's timely filing requirements vary by line of business. For commercial plans, the filing window is typically 180 days from the date of service for participating providers, though your specific provider agreement may specify a different timeframe — always refer to the contract. For MediCal managed care claims, California DHCS generally requires submission within 180 days of the date of service or date of payment by other payers, subject to state exceptions. For Medicare Advantage plans, CMS regulations require claims to be submitted within one calendar year from the date of service for non-contracted providers; contracted providers should follow the specific contract terms. Claims submitted after the applicable deadline are typically denied without appeal rights. Verify the current requirement for each specific Health Net plan through [provider.healthnet.com](https://provider.healthnet.com).

Health Net generally requires prior authorization for higher levels of behavioral health care, including residential treatment, medically managed detoxification, and partial hospitalization programs. Authorization requirements for intensive outpatient and standard outpatient services vary by plan design. For MediCal plans, California law under SB 855 (effective January 2022) requires Health Net to cover medically necessary treatment at the level of care determined by the clinician using ASAM or equivalent criteria, which has affected how authorizations are processed for substance use disorder treatment. Prior authorization can typically be submitted through the Health Net provider portal at [provider.healthnet.com](https://provider.healthnet.com) or by phone. Confirm current requirements for each specific plan type, as MediCal and commercial authorization rules differ substantially.

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