CommercialReimbursementMedium impact
20-799 Change to Financial Responsibility for Diagnostic Testing
Health Net·CA · Sleep Medicine, Pulmonology·Provider News
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Effective January 1, 2021, Health Net updated their Division of Financial Responsibility (DOFR) so that diagnostic testing performed at home now follows the same financial responsibility rules as outpatient facility testing. PPGs that are at risk for outpatient diagnostic testing are now also financially responsible for both facility/technical and professional components of home diagnostic testing, including home sleep studies.
Action Required
Billing team must review current DOFR agreements to determine if practice is at risk for outpatient diagnostic testing. If so, update billing workflows to handle financial responsibility for home diagnostic tests (both facility and professional components). Contact Health Net Provider Services within 60 days if clarification is needed on DOFR status.