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Medical Management

Medical Management Nomination Form

Use this form to refer a beneficiary to Case Management, Disease Management/Chronic Care or the Extended Care Health Option (ECHO) program.

  • For Case Management, fax form to: 1-888-965-8438
  • For Disease Management, fax form to: 1-888-965-8823
  • Created: Jan 11, 2018
  • Modified: Jan 11, 2018
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Email Consent Form

Use this form to grant permission for our Case Management department to communicate with a beneficiary via email.

You may fax this form to 1-888-965-8438 or mail it to:

Health Net Federal Services, LLC
Attention: Case Management
P.O. Box 9528
Virginia Beach, VA 23450-9528

  • Created: Feb 2, 2021
  • Modified: Feb 1, 2021
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