- Participating Physician Groups (PPG)
Encounter data submitted to Health Net can fail at the file level or the encounter level. If there is a file failure, the submitter is notified by the Capitated Claims/Encounter Department. The file must be corrected and resubmitted.
If the encounter file passes on to encounter level edits, the following reports are produced:
- Claims/Encounters Control Summary Reports - reports receipt/accept/reject totals for reconciliation.
- Encounter/Claims Rejection Report - identifies specifics for encounters that failed edits and require correction and resubmission.
Contact the Capitated Claims/Encounter Department if record-specific resubmission cannot be generated.