- Participating Physician Groups (PPG)
- Los Angeles
- San Diego
- San Joaquin
Eligibility Reports provide information about member assignment to participating physician groups (PPGs) and hospitals (when applicable) for members enrolled in all lines of business.
Health Net generates Eligibility Reports twice a month, on approximately the first and the fifteenth. Reports generated at the beginning of the month reflect member eligibility as of the first of the month. Reports generated mid-month include any retroactive member eligibility to date.
Health Net also generates the following report to help Medi-Cal providers keep track of members who need Department of Health Care Service (DHCS)-required examinations:
- 120-Day Initial Health Assessment Report - Lists members who have not had an initial health assessment (IHA) according to Health Net encounter data. Unlike eligibility reports, the 120-Day Initial Health Assessment (IHA) report includes the number of days the member has been enrolled in Health Net's Medi-Cal plan and the member's age.
Additional information on eligibility report field descriptions is available as follows:
Health Net sends the Medi-Cal electronic eligibility file (277 byte format (PDF)) to capitated participating physician groups (PPG), capitated hospitals and some direct network physicians. It lists assigned members eligible for the reporting month, terminated members and members' eligibility effective dates with their affiliated primary care physicians (PCPs).
Terminated members appear on the report during the month of termination and the following month. Members who were assigned to and terminated from a PPG during the same month (due to events such as retroactive PCP change or inappropriate assignment) display the same date for the Effective Date and Termination Date fields.
The file also displays the member's Medi-Cal redetermination date for use in identifying members who are nearing the date of Department of Health Care Services (DHCS) redetermination of their eligibility for Medi-Cal benefits and may need to reapply.