Noncompliance with Encounter Data Submission
Provider Type
- Participating Physician Groups (PPG)
- Ancillary
- Hospitals
Capitated providers, facilities and facilities with dual-risk contracts are contractually required to submit data for all services provided. Ongoing, uncorrected noncompliance with encounter data requirements is reported to the Health Net Delegation Oversight Committee (DOC).
Additionally, Failure to meet the California Department of Health Care Services (DHCS) QMED 2.0 requirements will result in:
- Negative impact to provider performance reporting.
- Increased risk of plan-level non-compliance.
- Required remediation and corrective action, including performance monitoring and escalation.