Medicare AdvantageAdministrativeMedium impact
23-642m Know What You Are Responsible for to Coordinate Care for Your D-SNP Patients
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has clarified care coordination responsibilities between Participating Physician Groups (PPGs) and the health plan for Dual Special Needs Plan (D-SNP) patients. This policy defines who handles care management, discharge notifications, prior authorizations, and case coordination.
Action Required
Immediately: Review care coordination responsibilities for D-SNP patients. PPGs must ensure timely notification of admissions, transfers, or discharges to Health Net when responsible for prior authorizations. Billing team should verify which services require PPG authorization versus health plan authorization. Coordinate with case managers and ensure proper documentation of post-discharge appointments and care coordination efforts.