- Participating Physician Groups (PPG)
This section contains information on eligibility reports to assist providers with determining eligibility.
The Health Net Medicare Advantage Capitation Activity Analysis Report (BRM 30) identifies and summarizes the following membership activity for the reporting period:
- Additions and cancellations.
- Transfers in and out of the participating physician group (PPG).
- Contract changes.
- Plan-type changes.
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 eligibility database, note new members, monitor retroactive cancellations or identify members who should receive new member welcome letters.
Additional information on file layouts and formatting of the Health Net Medicare Advantage Capitation Activity Analysis Report is available as follows:
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 and review adjustments made to capitation. The amounts reported are the current monthly capitation amounts plus any retroactive or current adjustment amounts. The report lists all members.
The summary portion of the report helps participating physician groups (PPGs) maintain accrual-based accounting records. It specifies the total capitation paid for the reporting month in the Net Remittance field. The report also summarizes adjustments made to this amount by adjustment type and month.
The Remittance Detail Report is distributed monthly by site level, but may be requested at the consolidated or physician level.
The Health Net Medicare Advantage Capitation Eligibility Report (BRM 42) lists alphabetically all members eligible for at least one day in the reporting month. Participating physician groups (PPGs) must 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.
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 or contracts 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 but 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 additional information. The Eligibility Report is generated at the end of the month for the following month.
Additional information on file layouts and formatting of the Health Net Medicare Advantage Eligibility Report is available as follows: