INSURER FILING GUIDE

Health Net

Use this public information to prepare your packet, then confirm the route on the insurer's own page.

AT A GLANCE

Claim facts

Member form	Member Reimbursement Form and Foreign Claim Questionnaire Number: FRM1584356EC01w_ndn Revision: 2024-12 (printed in month/year order) Open the insurer form
Portal upload	Not published by the insurer
Portal path	My Health Plan Coverage > My Claims > File a medical claim; an on-screen claim is published, but attachment upload is Not published by the insurer
Mail address	Health Net, LLC, Commercial Claims, PO Box 9040, Farmington, MO 63640-9040
Fax	Not published by the insurer
Attachments	Provider or facility name; provider or facility address; provider or facility telephone; provider Tax ID; date of service; diagnosis codes; procedure codes; proof of payment when the amount paid is more than $200
Deadline	1 year after the date of service
Outcome and status	Member account > My Plan Activity > Claims > Claims History
Processing time	30 calendar days after receipt for a clean covered claim
Caveats	The same commercial reimbursement form is published for medical and behavioral claims. PPO out-of-network benefits depend on the plan; HMO plans generally do not cover out-of-network services except stated exceptions. Medicare Advantage and Medicaid are outside this read.

STEP BY STEP

Read date: 10-09-2026

Confirm that the California plan includes out-of-network benefits. The published PPO evidence of coverage gives one year after the service date; HMO coverage generally excludes nonemergency out-of-network care. https://www.healthnet.com/content/dam/centene/healthnet/pdfs/broker/ca/sbg/fb/2026/full-network-ppo-gold-0-35-2026.pdf
Sign in, select My Health Plan Coverage, My Claims, then File a medical claim, and complete the on-screen claim. https://www.healthnet.com/portal/member/content/iwc/member/unprotected/support_contact/content/kb_plan_coverage_duals.action
Prepare a separate request per member and provider or facility. The current reimbursement form requires an itemized statement with provider details, tax identifier, service date, diagnosis and procedure codes, plus proof of payment when more than $200 was paid. https://www.healthnet.com/content/dam/centene/healthnet/pdfs/member/ca/hn-comm-claim-form-2024.pdf
NOT PUBLISHED: whether the member account accepts attachments, whether the PDF may be attached, file rules, packaging, or confirmation. Because attachment upload is not established, portal_upload is NOT PUBLISHED. https://www.healthnet.com/portal/member/content/iwc/member/unprotected/support_contact/content/kb_plan_coverage_duals.action
Check status at My Plan Activity, Claims, then Claims History. The published PPO evidence of coverage states a 30-calendar-day period for a clean covered claim. https://www.healthnet.com/en_us/members/faqs.html

Portal upload: NOT PUBLISHED
Portal: Health Net member account
Portal path: My Health Plan Coverage > My Claims > File a medical claim; an on-screen claim is published, but attachment upload is NOT PUBLISHED
Mail address: Health Net, LLC, Commercial Claims, PO Box 9040, Farmington, MO 63640-9040
Fax: NOT PUBLISHED
Attach: provider or facility name; provider or facility address; provider or facility telephone; provider Tax ID; date of service; diagnosis codes; procedure codes; proof of payment when the amount paid is more than $200
File types: NOT PUBLISHED
File size limit: NOT PUBLISHED
Maximum files: NOT PUBLISHED
One file or separate files: Separate form per member and per provider or facility; portal packaging details NOT PUBLISHED
Confirmation: NOT PUBLISHED
Status check: Member account > My Plan Activity > Claims > Claims History
Processing time: 30 calendar days after receipt for a clean covered claim
Member deadline: 1 year after the date of service
Deadline basis: Published California commercial PPO evidence of coverage; controlling plan document may differ
Mental health route: Health Net Behavioral Health

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.

Read on 10-09-2026 from https://www.healthnet.com/content/dam/centene/healthnet/pdfs/member/ca/hn-comm-claim-form-2024.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.