CurrentmhnPolicy N/A

Continuity of Care Request Process

Describes Health Net's Continuity of Care benefit request process, required form completion and submission methods, who to contact for help, and accessibility/non-discrimination resources; applies to members and providers seeking continuity of care.

Policy Summary

Payermhn

PolicyContinuity of Care Request Process

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionComplete a separate Health Net Continuity of Care Request Form for each provider and submit it by fax or mail.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1-866-295-4780fax number to submit Continuity of Care forms

P.O. Box 9103mailing address for Continuity of Care requests

1-800-675-6110member services/help line

Nurse reviewpost-submission action

Multiple translationslanguage/access options

Continuity of Care Coverage Criteria

Continuity of Care evaluation criteria

Requests for continuation are considered and evaluated according to the following factors; the form captures reasons and specific services requested.

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Requests are considered based on the plan benefit, applicable state rules, medical relevance, and clinical needs.

Reasons captured on the form

Scheduled procedure/operation
Acute and temporary condition
Serious and non-healing condition

Policy Summary

Payermhn

PolicyContinuity of Care Request Process

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionComplete a separate Health Net Continuity of Care Request Form for each provider and submit it by fax or mail.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Access process

How to obtain services and assistance, including contact points for language and disability-accessible support.

Complete a separate Health Net Continuity of Care Request Form for each provider; the form must be fully completed (the provider may assist in completion).

Submit the completed form by fax to 1-866-295-4780 or by mail to P.O. Box 9103, Van Nuys, CA 91409-9103 (see form instructions).

After submission, a nurse care manager will assess the request and Health Net will notify the member by phone and/or mail when the completed form is received.

Language and disability-access assistance

Call 1-800-675-6110 (TTY: 711) for language services and disability assistance.
Accessible formats available at no cost, such as accessible PDFs and large-print documents.
These services and materials are provided free of charge.

Members may contact Member Services for additional help; the form includes fields to indicate urgency (urgent vs routine).

Form Completion and Provider Actions

Documentation Required

Complete and submit a separate Continuity of Care Request Form per provider

Complete and submit a separate Health Net Continuity of Care Request Form for each provider; the form must be fully completed. The form may be completed with help from the provider, and requests will not be approved without a completed Continuity of Care Request Form. Fax the completed form to 1-866-295-4780 or use other submission methods listed on the form.

Complete a separate form for each provider you are requesting continuity for.
Provider may assist in completing the form.
Requests will not be approved without a completed Continuity of Care Request Form.
Fax completed form to 1-866-295-4780 (other submission options are available on the form).

Note

Request language interpretation or disability assistance (free)

Call 1-800-675-6110 (TTY: 711) to request language interpretation or disability assistance. Accessible formats (such as accessible PDFs and large-print documents) and interpreter services are available at no cost.

Telephone-based translation/interpretation support is available via 1-800-675-6110 (TTY: 711).
Disability assistance includes accessible PDFs and large-print documents.
These services are provided free of charge.

Definitions

Continuity of Care Request (member-submitted)

DefinitionA member-submitted request using Health Net's Continuity of Care Request Form to continue receiving services from an existing provider during coverage transitions; requests are reviewed and assessed by an assigned nurse care manager.

Decision factorsEach request is considered based on plan benefits, applicable state rules, medical relevance, and clinical needs.

Notification after submissionMember will be notified by phone and/or mail when the completed form is received.

Form handlingA separate Continuity of Care Request Form must be completed for each provider (provider may assist in completion).

Language Services and Disability Assistance

How to request servicesCall 1-800-675-6110 (TTY: 711) to request language services or disability assistance.

Types of language assistanceTelephone-based translation/interpretation services available in multiple languages (examples shown in the document).

Disability assistance optionsAccessible materials provided such as accessible PDFs and large-print documents.

CostThese language and disability assistance services are provided at no cost to the member.

CPT	Field for patient CPT code(s) to be provided on the form
Diagnosis	Field for patient diagnosis to be provided on the form

OpenPayer

Continuity of Care Request Process

Continuity of Care Coverage Criteria

Form Clinical Coding

Form Completion and Provider Actions

Definitions