CommercialAdministrativeMedium impact
20-800 Change to Financial Responsibility for Diagnostic Testing
Health Net·CA · Sleep Medicine, Pulmonology, Family Medicine +1 more·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net now requires Participating Physician Groups (PPGs) to take financial responsibility for home diagnostic testing (both facility/technical and professional components) if they already have risk for outpatient diagnostic testing under their Division of Financial Responsibility (DOFR). This includes procedures like home sleep studies for sleep apnea diagnosis.
Action Required
PPGs with diagnostic testing risk in their DOFR should immediately verify their contract terms and understand they are now financially responsible for home diagnostic testing including both facility/technical and professional components. Contact Health Net Provider Services within 60 days if clarification is needed regarding financial responsibility status.