Calendar of Required PPG Submissions
Provider Type
- Participating Physician Groups (PPG)
Counties Covered
- Fresno
- Kern
- Kings
- Los Angeles
- Madera
- Sacramento
- 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 |
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.