All PlansAdministrativeHigh impact
23-1120 Updates to Monitor Suspended and Excluded Lists to Prevent Getting Terminated
Health Net·CA·Reimbursement
Effective date
Dec 19, 2023
We identified it
Jun 20, 2026
Summary
Health Net is adding the Federal Employee Health Benefit Plan (FEHBP) sanction and debarment list to their provider exclusion monitoring process, effective December 19, 2023. Providers on any exclusion list (OIG, SIPL, RPD, CMS Preclusion, or FEHBP) will be terminated from Health Net for all applicable product lines, and the practice must conduct monthly monitoring of these lists to avoid termination.
Action Required
Immediately: Billing team must establish monthly monitoring of all five exclusion lists (OIG LEIE, SIPL, RPD, CMS Preclusion List, and FEHBP) for all providers, subcontractors, and delegated entities. Access lists through Health Net provider portal and contact plan representatives for FEHBP data. Conduct 12-month claims look-back review for any identified excluded providers and notify affected members. Failure to monitor will result in provider termination from Health Net for all product lines.