Most capitation reports are available at a consolidated or site level, while there are two reports that offer data sorted at a physician level.

The Health Net Medicare Advantage Capitation Eligibility Report (BRM 42) lists alphabetically all members affiliated to participating physician groups (PPGs) at the time the report runs. Providers can use this report to verify that a member is eligible to receive services. In addition, providers must check the member's effective and cancellation dates to ensure eligibility on a particular day.

The Eligibility Report is available monthly at the consolidated, site or physician levels and alphabetically lists all members eligible for at least one day in the reporting month. PPGs must use this report to verify that a member is eligible to receive services for the dates of service.

PPGs may use the Eligibility Report in conjunction with the Remittance Detail Report to verify that they have received the correct capitation and that the capitation includes members added retroactively. The summary portion of this report lists the number of members eligible with the PPG at least one day during the month and at month's end. The Eligibility Report is distributed monthly by site level and may be requested at the consolidated or physician level.

The Eligibility Report reflects membership information as it appears in our membership system on the date the report is run. If a newly added employer group is not included by the date the report is run or if an existing employer group has not reported all membership changes, the Eligibility Report does not reflect this information. Refer to the Eligibility Guarantee discussion under the Claims and Provider Reimbursement topic for more information. The Eligibility Report is generated at the end of the month for the following month.

The Health Net Medicare Advantage Capitation Activity Analysis Report (BRM 30) is available monthly at the consolidated or site levels (all member-related activities during the prior month), and may be requested at the consolidated level for primary PPGs. This report identifies and summarizes the following membership activity for the reporting period:

The Activity Analysis Report is available monthly by site level, but PPGs may request it at the consolidated level. Providers who wish to be informed more often can request to change activity analysis reporting from monthly to weekly. Contact your Health Net Provider Network Management representative to request the change.

PPGs may use the report to update their system, note new members, monitor retroactive cancellations or identify members who should receive new member welcome letters.

Additional information on report layouts and formatting of the Health Net Medicare Advantage Capitation Activity Analysis Report is available at Sample Health Net Medicare Advantage Capitation Activity Analysis Report - BRM 30 (PDF).

The Health Net Medicare Advantage Capitation Remittance Detail Report (BRM 20) displays the capitation remittance for each member and is used to reconcile monthly capitation payments. The amounts reported are the current monthly capitation amounts plus any retroactive or current adjustment amounts.

The Remittance Detail Report is available monthly at the consolidated, site or physician level. The report displays the capitation remittance for each member and is used to reconcile monthly capitation payments and review adjustments made to capitation. The amounts reported are the current month capitation amounts plus any retroactive or current adjustment amounts. The report lists all members.

The summary portion of the report helps PPGs maintain accrual-based accounting records. It specifies the total capitation generated for the reporting month in the Net Remittance field. The report also summarizes amounts by months/years incurred.

The Remittance Detail Report is distributed monthly by PPG site level and may be requested at the primary PPG consolidated or physician level.

The Health Net Medicare Advantage Capitation Eligibility Summary Report By Group/Provider (BRM 11) lists, by employer group, the number of members the PPG has enrolled and identifies each employer group's plan code and specific supplemental benefits the employer group has purchased.

The Eligibility Summary by Group Report is available at the consolidated or site level. It includes the employer group ID, group name, Plan code, supplemental benefits (if applicable), and eligible member count. Refer to ACE_RPT_BRM_11.

The CMS Monthly Membership Report (MMR) – BRM 18 is the basic accounting file of beneficiary-level payments and adjustments for Medicare Advantage. The payment reported on the MMR is the capitated payment for each beneficiary enrolled in the Plan. The report continues to display some beneficiary-level status and also includes information about the risk adjustment factor and payment rate. Note: this is not an enrollment report. All records in this report are 495 bytes long.

CMS Monthly report – BRM 25 lists Hierarchical Condition Categories (HCCs), demographic data, and calculated risk scores used to determine payments based on beneficiary health. All records in this report are 220 bytes long.

The SB 260 Reconciliation Report BRM 28 provides enrollment and capitation payment summary at the product level for the prior 18 months. All records in this report are 1024 bytes long. This report has three record types: header, detail and trailer. Data expressed in the X format is left-justified and blank-filled. Data expressed in the nine format is right-justified and zero-filled.

Health Net offers providers these capitation reports through the portal as a default to help reconcile eligibility and remittance payments.