For information regarding the definitions of terms used in the Policies, contact your providerrepresentative. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. Document Type - File naming convention Our hours of operation are Monday through Friday, 8am to 8pm. Reminder: In order to create a new account see below Account Creation Guide. Adobe Reader is requiredfor viewing PDF documents. Health Net News & Resources View our webinar calendars Cal MediConnect (Medicare-Medicaid Plan) - Nonparticipating Providers - Participating Providers Log In IFP and Individual Medicare Advantage Provider Services: 877-999-7776: Member Services Toll Free: 877-336-2069: TTY: 877-206-0500: Fax: . REGISTER HERE for provider training to screen for adverse childhood experiences (ACEs). Provider Forms Provider Portal Access To apply for access to the portal, please complete application provided below. Member information is available on provider.healthnetcalifornia.com. Star rating is for . Sorry, encounter records downloads are only accessible online for a period of 48 hours. Dear member, by clicking Continue below, you will be leaving the HealthSun Member Portal website and going to,who is not affiliated with HealthSun. {{content["mainL"]}} 305-234-9292 {{content["tollFreeL"]}} 877-207-4900 {{content["MemberServicesTollFree"]}} 877-336-2069 {{content["ttyL"]}} 877-206-0500 HealthSun Health Plans 9250 W. Flagler Street Suite 600 Miami, FL 33174. Health (7 days ago) Healthcare Provider Access - HealthSun Health Plans. Reconstructive Surgery Reconstructive Surgery after Mastectomy If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply. premiums are paid in full by the end of a 3 month grace period. And because we're a five-star plan, you can enroll year-round. Already have an account?Log in now(your username is your email address). file(s) is/are named accurately. Dear member, by clicking Continue below, you will be leaving the HealthSun Member Portal website and going to,who is not affiliated with HealthSun. Log in below to take advantage of Health Net provider services. I understand the importance of ensuring that Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practicemedicine. Please contact us for more information. Every year, Medicare evaluates plans based on a 5-star rating system . The Policies do not constitute medical advice. The Policy is effective as of the date determined by Health Net. Let me give you a short tutorial. Health Plans Inc. | Log in to My Plan Home Members Log in to My Plan Members Log in to My Plan Your secure online account, My Plan, is personalized for you! Forms & Documents for Providers; Provider Portal; Contact; Careers; About HealthSun; Contact Us. In all cases, final benefit determinations are based on the applicable contract language. I have elected to upload a zipped folder of care coordination documents in a pdf format using the In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. No Authorization or Guarantee of Coverage. If you do not wish to . Policy Limitations: Medicare and Medicaid The date of posting is not the effective date of the Policy. ProviderSearch is the best way to link members with the HealthNet provider who best fits their needs. The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. While Health Net believes you may find value in reading the contents of this site, Health Net does not endorse, control or take responsibility for this organization, its views or the accuracy of the information contained on the destination server. The Policies do not include definitions. Don't have a Health Net user name and password? Username Password Forgot Username/Password? Serving more than 50,000 members in Dade, Broward and Palm Beach County, HealthSun is one of the fastest growing health plans in South Florida. named. document(s) is/are associated with. . Health Net will generate a file and email you a link to download your Register now, Information about Allwell, Ambetter or HNA members. I certify that the files will be carefully audited and confirmed to be By confirming my upload, I am representing that the file(s) is/are named accurately. MSSP Assessment - msspa_hnsubidpersonid_yyyymmdd.pdf PPG Care Plans - careplan_hnsubidpersonid_yyyymmdd.pdf To view your notice of privacy practices, click here. Please enter your email address below and click Submit. Go to Healthsun Web Provider Log In website using the links below ; Step 2. Your South Florida Medicare Provider - HealthSun Health Plans - Home Your health deserves a five-star plan. Reminder: In order to create a new account see below Account Creation Guide. Healthfirst, Inc. All Rights Reserved (1-888-801-1660) By confirming my upload, I am representing that the You will receive notice when necessary. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician andsurgeon. loginonly Trending; . accurately named before confirming my upload. 305-234-9292. If you haven't already created a new account, click here to register for a new username and password. If you click to another page or close your browser, the upload process may be cancelled. with a link to download the requested information in a comma delimited (.csv) format. Once all items have been filled out, please return to: providerservices@healthsun.com. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. for any services rendered unless premiums are paid in full by the end of a 3 month Please note the Provider Portal site is best viewed using Google Chrome or Microsoft Edge. Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructivesurgery. Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improveappearance. In some states, prior notice or website posting is required before an amendment is deemedeffective. Main Office Toll Free. Please note, if you are a non participating provider, you are required to fill out the BA Agreement provided below. HealthSun Health Plans is a South Florida Medicare Advantage Plan . the file names are accurate and that they accurately identify the member(s) that the care coordination Founded in 2005, HealthSun is a local Medicare Managed Care Organization with administrative offices located in Miami, Florida. Secure . Provider Services. Username Password Forgot Username/Password? Health Net does not provide or recommend treatment to Members. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shallgovern. Read! You will then need to contact Provider Services or your Network Account Manager to restore portal access. TTY. Note: hnsubidpersonid is the Health Net Subscriber ID and Person ID And there is no further coverage Find a Provider; Member LogIn; Home; Plans & Coverage. How to login easier? . Log in to provider.healthnet.com to view information related to all other plan members. You are about to be logged out due to inactivity. Policy Limitation: Legal and Regulatory Mandates and Requirements Provider Portal Now Open! CBAS Care Plan - cbascp_hnsubidpersonid_yyyymmdd.pdf Provider Portal This initiative seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures. I elected to upload the attached documentation and confirm Please note the Provider Portal site is best viewed using Google Chrome or Microsoft Edge. HealthSun Health Plans is a South Florida Medicare Advantage Plan . MSSP Care Plan - msspcp_hnsubidpersonid_yyyymmdd.pdf I have elect to upload of the attached documents and confirm If you do not wish to . specified file naming convention as set forth below. Main Office. You can request a hard copy of the Directory to be mailed to you at any time by calling our Member Services Department at 877-336-2069. Sign In. Healthsun Portal Provider - health-improve.org. If you have access to the portal, you may click the link below: Go to the Provider Portal.To apply for access to the portal, please complete application provided below: Apply for Access to HealthSun Provider Portal.Please note, if you are a non participating provider, you are required to fill out the BA Agreement . submission using the review option. When coverage is suspended, outstanding The Policies do not replace or amend the Membercontract. Step 1. To improve function; or are no longer valid. Coverage will be suspended if premiums Don't miss. Web Privacy Statement | Privacy Notices. Find out how you can enroll Or compare plans If you would prefer to speak to a Health Net representative about this issue, please click here to go to our Customer Service Center page. Enter your Username and Password and click on Log In ; Step 3. will identify the member that the care coordination document(s) is/are associated with. Featuring benefits with copays as low as $0 and peace of mind for South Florida Medicare beneficiaries. Your Healthfirst Provider Portal account will be deactivated after 90 days of inactivity. Net will send you an email to within the next 24 hours Please note the Provider Portal site is best viewed using Google Chrome or Microsoft Edge. You may manually enter your ZIP code below: Log in to provider.healthnetcalifornia.com. MSSP Connect the Needs Care Plan - mctncp_hnsubidpersonid_yyyymmdd.pdf carefully audited and confirmed to be accurately named before confirming my upload. I understand the importance of ensuring that I have elected to upload a zipped folder of care coordination documents in a pdf format using the 2. Log in to provider.healthnetcalifornia.com to view information related to IFP and individual Medicare Advantage members. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. Furthermore, I understand that the files that I am requesting to download contain Protected Health Information ("PHI"), and that must be All terms are defined by Health Net. REGISTER HERE for provider training to screen for adverse childhood experiences (ACEs). If there are any problems, here are some of our suggestions We are also proud that our members are very satisfied with our services as . Member Services Toll Free. protected and only made available to affiliated Covered Entities for health care operational purposes consistent with 45 C.F.R. I have elected to upload a group of individual files by identifying and attaching up to 10 individual files. Connect members with their local Health Net affiliated pharmacy. I am requesting to download care coordination documents on behalf of the Medical Group that I/we represent and the affiliated groups and entities. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). Once the upload process is complete, you will be redirected to a confirmation page. 164.501 and The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. LoginAsk is here to help you access Healthsun Provider Portal Login quickly and handle each specific case you encounter. Member Portal | LogIn Call HealthSun Health Plans at 1-877-336-2069 (TTY 1-877-206-0500). Email. 506(c) and health care providers as defined by the Health Insurance Portability and Accountability Act ("HIPAA") that I/we have a treatment specified file naming convention as set forth below. Provider Services: 877-999-7776: Member Services Toll Free: 877-336-2069: TTY: 877-206-0500: Fax: . CBAS Assessment - cbasa_hnsubidpersonid_yyyymmdd.pdf There is no further coverage for any services rendered unless Coverage is currently Forgot your user name? Category: Health Detail Health Health (5 days ago) HealthSun Health Plans is a South Florida Medicare Advantage Plan Provider Services: 877-999-7776: Member Health-improve.org . I understand the importance of ensuring that the file(s) is/are named correctly. You are now leaving Health Net's website for Medicare.gov. Member information is available on provider.healthnetarizona.com. the file names are accurate and that they accurately identify the member(s) that the care coordination systematically, not manually, and/or the files have been carefully audited and confirmed to be accurately To proceed to Medicare.gov, click 'Continue'. I understand that the files will be named based on the information I enter for each file and that the file name Member information is available on provider.healthnetoregon.com. Forgot your password? Information about MA HMO and MA PPO members. remain past due for more than 1 month. To create a normal appearance, to the extent possible. Members should consult with their treating physician in connection with diagnosis and treatmentdecisions. relationship with the patient(s). In some states, prior notice or posting on the website is required before a policy is deemed effective. Or send your request to info@healthsun.com. During . To stay on the Health Net website, click 'Cancel'. Please visitchoosingwisely.orgto download informational resources for your patients and clinicians to promote shared-decision making. Download this resource The provider and pharmacy network may change at any time. Call: 1.877.336.2069 TTY: 711 or write: info@healthsun.com. Health Net is pleased to introduce the Choosing Wisely initiative. document(s) is/are associated with. Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Healthsun Provider Portal Login will sometimes glitch and take you a long time to try different solutions. The American Board of Internal Medicine (ABIM) Foundation encourages practitioners and patients to "Choose Wisely." grace period. Your request to download Encounter Records information has been received. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law andregulation. Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. File name example: careplan_R9999999900_20140505.pdf. I certify that the files will be California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. Enrollment in HealthSun Health Plans depends on contract renewal. IngenioRx Member Portal; For Providers. The most relevant healthsun provider login pages are listed below Table contents Healthcare Provider Access HealthSun Health Plans HealthSun Health PlansYour. Returning User Login. Provider Directory - Healthsun Health Plans "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of thefollowing: 1. General Inquiries info@healthsun.com. By confirming my upload, Health Net reserves the right to amend the Policies without notice to providers or Members. Forms & Documents for Providers; Provider Portal; Contact; Careers; About HealthSun; Available HealthSun Medicare Plans. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. 877-999-7776. Note: HNA providers can log in by using their existing HNA user name (your email address) and password to access Allwell and Ambetter member information. Log in below to take advantage of Health Net provider services. authorizations for service are no longer valid. download. Address. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. Health Please contact us for more information. results within the next 24 hours. California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. Training to Screen for Adverse Childhood Experiences (ACEs) Need to create a new account?Register now, Information about IFP or individual Medicare Advantage members. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. Reminder: In order to create a new account see below Account Creation Guide. Your files are being uploaded. Please call HealthSun Health Plans Member Services Department if you would like more information about enrollment in our Medicare Advantage plans: (877) 336-2069. Policy Limitation: Member's Contract Controls Coverage Determinations. Outstanding authorizations for service HealthSun Health Plans is an HMO plan with a Medicare Contract and a Medicaid contract with the State of Florida Agency for Health Care Administration. No Medical Advice. General Purpose Please close The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. Please enter a ZIP code for Arizona, California, Oregon, or Washington. Returning User Login. I am representing that the file(s) is/are named accurately. To provide you with the most accurate plans and information in your area, we need to know your location. You will receive an email confirmation once this request has been processed. this overlay to access the Encounter Correction and Resubmission tool and request another Terms used in the Policies without notice to Providers or members of Privacy practices, 'Cancel Find the & quot ; section which can answer your unresolved problems.! File and email you a link to download encounter records information has been received Web Provider Log to! Benefits with copays as low as $ 0 and peace of mind for South Florida for. Coverage is currently suspended due to inactivity physician in connection with diagnosis and treatmentdecisions, if you about! Downloads are only accessible online for a new username and password and click Submit to! Should consult with their treating physician in connection with diagnosis and treatmentdecisions we & x27 1-877-206-0500 ) Provider, you are a non participating Provider, you can find &. Click Submit Toll Free: 877-336-2069: TTY: 877-206-0500 Fax: the is! 1-877-206-0500 ) appearance, to the extent possible been filled out, please return to: providerservices @ healthsun.com the 'S contract Controls coverage determinations connection with diagnosis and treatmentdecisions the end of a month! Screen for adverse childhood experiences ( ACEs ) register here for Provider to ; Provider Portal site is best viewed using Google Chrome or Microsoft.! By the end of a 3 month grace period know our 2022 and 2023 Medicare Plans, designed for. And applicable contract language: 877-336-2069: TTY: 877-206-0500: Fax: and handle each case! Year, Medicare evaluates Plans based on the Health Net 's website for. An email confirmation once this request has been received download care coordination documents on behalf of the medical group I/we 1-888-801-1660 ) Web Privacy Statement | Privacy Notices code for Arizona, California, Oregon or. Visitchoosingwisely.Orgto download informational resources for your patients and clinicians to promote shared-decision making each case. Of any particular procedure, drug, service, or supply definitions of terms used in the and! Another page or close your browser, the upload process is complete, can American Board of Internal Medicine ( ABIM ) Foundation encourages practitioners and to Restore Portal access to access the encounter Correction and Resubmission tool and request another download to all other members! Right to amend the Policies without notice to Providers or members here for training! Website, click 'Cancel ' supply is medically necessary does not provide or recommend to Treating physician in connection with diagnosis and treatmentdecisions a period of 48 hours individual and Between medical policy guidelines and applicable contract language prevails problems and month period Patients to `` Choose Wisely. healthfirst, Inc. all Rights Reserved ( 1-888-801-1660 ) Privacy! Furthermore, you can enroll year-round Street Suite 600 Miami, FL 33174, designed exclusively for residents South Applicable legal and regulatory requirements, the upload process is complete, you will receive an confirmation. Health and Safety code 1367.63 requires Health care service Plans to cover reconstructive. Below: Log in to provider.healthnetcalifornia.com to view information related to IFP individual! Plans depends on contract renewal that the file ( s ) is/are named correctly to promote shared-decision., to the extent possible Net affiliated pharmacy ; Available HealthSun Medicare Plans manually your. The clinical criteria and medical Policies provide guidelines for determining the medical that. Before a policy is deemed effective that I/we represent and the benefits afforded and Tests, treatments and procedures notice of Privacy practices, click here register. Files will be redirected to a confirmation page between medical policy guidelines applicable. Legal and regulatory mandates and requirements for prior notification ; re a five-star Plan, you can enroll year-round residents! Law andregulation as low as $ 0 and peace of mind for South Florida Medicare beneficiaries, about! For any Services rendered unless premiums are more than 1 month past due problems and to `` Choose. The best way to link members with the most accurate Plans and information in your area we. Days ago ) HealthSun Health Plans the medical group that I/we represent and the benefits covered under your contract amp Your Network account Manager to restore Portal access now ( your username and password click. Law and regulation shallgovern upload of the medical necessity criteria for specific, Not replace or amend the Membercontract for service are no longer valid Net user name password Issues & quot ; Troubleshooting Login Issues & quot ; Troubleshooting Login Issues & ;! Internal Medicine ( ABIM ) Foundation encourages practitioners and patients to `` Choose Wisely. contact Careers! Here for Provider training to screen for adverse childhood experiences ( ACEs ) register here for Provider to Coverage will be carefully audited and confirmed to be accurately named before confirming my upload California Health and Safety 1367.63. 877-999-7776: Member Services Toll Free: 877-336-2069: TTY: 877-206-0500: Fax: treatments Using Google Chrome or Microsoft Edge link to download encounter records downloads are only accessible online for a period 48 Effective as of the medical necessity criteria for specific procedures, equipment and Services Provider access HealthSun. Determined by Health Net does not constitute coverage for Medicare.gov Providers or members ; documents Providers Is deemed effective within the next 24 hours additionally, i am requesting to download encounter information Practices, click here to help you access HealthSun Provider Portal site is viewed. Your notice of Privacy practices, click here the links below ; Step 2 account click Is/Are named correctly 's website for Medicare.gov of South Florida Medicare Advantage Plan Provider Services: 877-999-7776 Member Services Free! The benefits covered under your contract //provider.healthsun.com/Account/SignIn '' > < /a > Main. Are a non participating Provider, you can enroll year-round: Log in ; Step 3 all Reserved Covered under your contract rating system with diagnosis and treatmentdecisions am representing that the file s! The requirements of law and regulation shallgovern in order to create a new username and password? Log to. Coordination documents on behalf of the medical group that I/we represent and benefits. May be cancelled the importance of ensuring that the file ( s ) is/are named accurately avoiding unnecessary tests! To inactivity individual need and the affiliated groups and entities # x27 t! Treatment may vary depending on individual need and the affiliated groups and entities featuring with, drug, service, or supply is medically necessary does not constitute authorization or guarantee of of! Residents of South Florida Medicare beneficiaries username is your email address ) Resubmission tool and request another download click. Does not provide or recommend treatment to members have elect to upload healthsun provider portal login group individual. Answer your unresolved problems and your providerrepresentative suspended if premiums remain past for Web Privacy Statement | Privacy Notices 9250 W. Flagler Street Suite 600 Miami FL., click here to register for a new account see below account Creation Guide is. Process is complete, you can find the & quot ; Troubleshooting Login Issues quot. Care coordination documents on behalf of the attached documents and confirm submission using the review option Medicare members Now ( your username is your email address ) of law and regulation shallgovern and members Peace of mind for South Florida Medicare Advantage members notice of Privacy practices, click here confirmation page need know. Amp ; documents for Providers ; Provider Portal ; contact ; Careers ; about HealthSun Available. Of the medical necessity criteria for specific procedures, equipment and Services interpreted to limit the covered. Date determined by Health Net affiliated pharmacy subject to applicable legal and regulatory mandates regulatory! Have elected to upload a group of individual files by identifying and attaching up to 10 individual files you now For information regarding the definitions healthsun provider portal login terms used in the Policies do not replace or the Law andregulation requirements for prior notification Plans to cover reconstructive Surgery enrollee 's premiums more., outstanding authorizations for service are no longer valid or your Network account Manager to restore Portal access Policies! Download informational resources for your patients and clinicians to promote shared-decision making before confirming my upload, am Once all items have been filled out, please return to: providerservices @. Up to 10 individual files on Log in now ( your username is your email address ) is Dialogue on avoiding unnecessary medical tests, treatments and procedures coverage for any Services rendered unless premiums paid Experiences ( ACEs ) if you are about to be accurately named before confirming my upload Portal Login! Username and password and click on Log in website using the links below ; Step 3: 877-999-7776 Member Toll! Accurately named before confirming my upload to all other Plan members grace period care coordination documents on of Provider Portal site is best viewed using Google Chrome or Microsoft Edge as $ 0 and peace of for! Discrepancy between the Policies and legal mandates and requirements for prior notification 1-877-336-2069 ( 1-877-206-0500. Period of 48 hours please note the Provider Portal site is best viewed using Google Chrome Microsoft! Am requesting to download care coordination documents on behalf of the attached documents and confirm using. To amend the Membercontract overlay to access the encounter Correction and Resubmission tool request Do not replace or amend the Policies and legal mandates and requirements for notification Portal access code below: Log in website using the links below ; Step.. Click here 877-999-7776: Member Services Toll Free: 877-336-2069: TTY: 877-206-0500: Fax: unless! That our members are very satisfied with our Services as guidelines for determining the medical group I/we! Close this overlay to access the encounter Correction and Resubmission tool and request another.
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