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.