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Calendar of Required PPG Submissions

Provider Type

  • Participating Physician Groups (PPG)

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Riverside
  • Sacramento
  • San Bernardino
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

Documents to be Submitted

Due Date

Financial Statements (Annual Audited)

150 days after close of fiscal year

Financial Statements (Quarterly Updates)

45 days after close of quarter

Monthly Timeliness Reports (MTR) Claims

15th calendar day after end of each month

(MTR) Quarter Submission Claims

Last calendar day of month following close of quarter

Monthly Encounter Data Submission

Within 30 days of end of month of service

Prior year 4th Quarter Credentialing Report

February 15

1st Quarter CR Report

May 15

2nd Quarter CR Report

August15

3rd Quarter CR Report

November 15

Physician and Provider Contract Cover
and Signature Page

On execution of contract

Subcontract Templates

January 5

Utilization Management (UM) Program Description

February 15

UM Work Plan

February 15

Prior Year 4th Quarter UM Report/Annual Evaluation

February 15

1st Quarter UM Report

May 15

2nd Quarter UM Report

August 15

3rd Quarter UM Report

November 15

California Children's Services (CCS) Monthly Reports (Medi-Cal only)

10th calendar day after end of each month

Health Net does not delegate responsibility for quality improvement (QI) functions and processes. Subsequently, Health Net does not require QI reports from participating physician groups (PPGs). PPGs are required to participate in and cooperate with QI activities, including Healthcare Effectiveness Data and Information Set (HEDIS®), access surveys, disease management, and other quality initiatives.

To access the current year UM report templates, workplans and instruction, visit the Industry Collaboration Effort (ICE) website at www.iceforhealth.org.

Last Updated: 08/06/2021