CommercialAdministrativeMedium impact
20-927 Notice of Correction for 20-800, Change to Financial Responsibility for Diagnostic Testing
Health Net·CA · Sleep Medicine, Pulmonology·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net clarified that in-home sleep studies follow the same Division of Financial Responsibility (DOFR) rules as outpatient facility diagnostic testing. Participating physician groups with diagnostic testing risk are financially responsible for both technical and professional components of home sleep studies.
Action Required
Immediately: Billing team must verify DOFR agreements to determine if practice is financially responsible for in-home sleep studies. If responsible under diagnostic testing category, update billing workflows to capture both technical and professional components. Contact Health Net Provider Services within 60 days with questions.