Network Participation Request

ATTENTION: If you are currently a provider participating in one or more Health Net of California networks and are having issues registering for the new provider portal, DO NOT submit the network participation forms below.

Instead, please send an email with your contact information so a provider network representative can reach out and assist.

• Network Participation Request
• Medical Policies
• Medicare Information
• EDI
• Cal MediConnect Non-Participating Providers Overview

Thank you for your interest in obtaining an agreement for participation in the Health Net provider network. To request participation in the Health Net network:

1. Identify your specialty (Practitioner or Organizational).
2. Download and complete the correct participation form.
3. Return your completed form to the location indicated on the form.

Network Participation Request – California

Thank you for your interest in obtaining an agreement for participation in the Health Net of California provider network. Please note that the participation request forms below apply only to physicians, licensed health care professionals and ancillary providers with practice locations in California.

The list below will assist you in determining which application applies to you or your organization. Specific instructions on submission are included within each application.