Reports

Provider Type

  • Participating Physician Groups (PPG)

The following site-level reports are generated monthly by Health Net and sent to participating providers. Consolidated- and physician-level reports are available on request.

Report Option

Description

Consolidated

Allows the participating physician group (PPG) and all satellite offices to receive one integrated report.

Site

Allows the PPG to have all its satellites receive their own sets of reports.

Physician

Allows each primary care physician (PCP) within a PPG to receive an individual report. This option is only available for the Eligibility and Remittance Detail report.

The following reports are available to PPGs:

Report #

Name

Description

BRM 11

Eligibility Summary by Employer Group Report

Lists members by employer group.

BRM 18

CMS Monthly Membership Report

Lists Medicare-specific attributes and premium amounts.

BRM 20

Remittance Detail Report

Details the capitation and adjustments for each member.

BRM 25

CMS Risk Adjustment Model Output Report

Lists hierarchical condition category (HCC) codes used by the Centers for Medicare & Medicaid Services (CMS) to determine risk scores.

BRM 28

SB260 Reconciliation Report

Summarizes eligibility and remittance data.

BRM 30 (monthly) or BRW 30 (weekly)

Activity Analysis Report (available weekly or monthly)

Details all member-related activity during the prior reporting period.

  • Weekly report includes only members with a transaction/change – new member adds, transfers, cancellations/disenrollment, PCP changes, etc.

BRM 42

Expanded Eligibility Report

Lists all members approved by CMS who receive their Medicare benefits from Health Net.