MedicaidAdministrativeMedium impact
22-158m Verify Member Eligibility with IVR Self-Service Tool
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net and CalViva Health have implemented a new IVR self-service tool that allows providers to verify member eligibility by phone using automated prompts. Providers can now call 888-893-1569 and use their NPI, TIN, and member information to get real-time eligibility status without waiting on hold.
Action Required
Immediately: Train front desk staff and billing team to use the new IVR eligibility verification system at 888-893-1569. Update eligibility verification procedures to include IVR as primary option before calling provider services. Staff must have NPI and TIN readily available and follow the specific prompts: enter NPI/TIN, member ID, date of birth (dd/mm/yyyy), zip code, then select option 3 for eligibility.