Medicare AdvantageAdministrativeMedium impact
20-1034 Full-Risk, Dual-Eligible, Special Needs Member Admissions and Discharge Data Required for SNFs and Hospitals
Health Net·CA·Coding
Effective date
Mar 1, 2021
We identified it
Jun 20, 2026
Summary
Starting March 1, 2021, hospitals and skilled nursing facilities must submit admission/discharge/transfer data for dual-eligible special needs plan members to Health Net's Hospital Notification Unit within 24 hours of admission. This is in addition to existing reporting requirements to participating provider groups.
Action Required
By March 1, 2021: Hospital and SNF billing teams must establish new workflow to report dual-eligible special needs member admissions to Health Net Hospital Notification Unit within 24 hours via fax at 1-800-676-7969 or phone at 1-800-995-7890. Include required data elements: member demographics, MBI, dates, ICD-10 diagnosis codes, and discharge information when available. This is in addition to existing PPG reporting requirements.