MedicaidAdministrativeMedium impact
21-545 Support More Medi-Cal Members as Direct Network Launches in San Joaquin County
Health Net·CA·Prior Authorization
Effective date
Oct 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net is launching a direct fee-for-service network for Medi-Cal members in San Joaquin County effective October 1, 2021. Providers must now submit claims directly to Health Net for members assigned to direct network PCPs and obtain prior authorization from Health Net for medical management decisions.
Action Required
Immediately: Billing team must identify Medi-Cal members in San Joaquin County with ID cards showing 'Direct Network' as PPG. Submit claims directly to Health Net at PO Box 9020, Farmington, MO 63640-9020 or electronically via clearinghouse. Providers must obtain prior authorization from Health Net for direct network Medi-Cal members and verify member eligibility before each appointment using Health Net's provider website or Provider Services Center.