26-1019 State of Emergency: Gann Fire in Calaveras County

Immediately: Billing team and provider services staff must implement the following emergency procedures for all Health Net claims from Calaveras County members affected by the Gann Fire: (1) Suspend standard prior authorization, precertification, and referral time limits—contact Health Net Provider Services Center (line of business-specific numbers provided) to request shortened approval timelines and extended validity periods for existing authorizations; (2) Approve out-of-network provider and facility services without standard network restrictions if contracting providers become unavailable due to fire impact; (3) Process medical equipment/supply replacement authorizations with expedited approval; (4) Extend claims filing deadlines—contact Provider Services Center for specific extended timelines and update billing system to reflect new deadline dates; (5) For prescriptions: approve all essential medications for members who lost or evacuated with their medications, suspend refill limitations, and allow refills at out-of-network pharmacies; (6) Flag all Calaveras County claims in billing system with emergency status to ensure manual review and expedited processing. Coordinate with front desk to direct affected members to Health Net Emergency Response Line (800-400-8987, 8am-6pm PT) for insurance cards, prescription assistance, and mental health referrals. Contact appropriate Health Net Provider Services line (HMO/POS/PPO: 800-641-7761; Medicare: 800-929-9224; Medi-Cal: 800-675-6110) for guidance on individual claim situations. Failure to implement these flexibilities may delay critical care access for fire-affected members and result in preventable claim denials.