21-392 Get Access to Member Eligibility and Capitation Reports
Date: 06/28/21
This information applies to Participating Physician Groups (PPGs).
Receive activity analysis reports monthly or weekly for Medicare Advantage members
Health Net provides monthly capitation eligibility and remittance detail reports to assist providers with membership eligibility. The reports provide information about members assigned to participating physician groups (PPGs) and hospitals. Providers who wish to be informed of new members enrolled and other changes more often can request a weekly Activity Analysis Report.
How to request a weekly activity analysis report
Contact the Health Net Provider Services Center at the numbers listed below to make a request to change activity analysis reporting from monthly to weekly.
Reporting period for weekly vs. monthly
Health Net runs a capitation Activity Analysis Report on a weekly or monthly basis. The report is used to identify membership activity for the reporting period, such as:
- New and cancelled members.
- Reinstatements.
- Transfers in and out of the PPG.
- Contract changes.
- Plan-type changes.
Below are examples of how the reports are run for both:
- Weekly activity reports – This report starts on a Saturday and ends on the following Friday. The report will be available on Monday.
- Monthly activity reports – This report is on a schedule and ends on the 4th Friday of each month. The report will be available on Monday.
Reports available for providers
To access the reports listed below:
- Providers serving Medicare employer group members – Log on to the provider portal and search under Provider Reports > Available Reports > Capitation. Providers can also access and view file layouts under Provider Reports > Data File Record Layouts > Seniority Plus.
- Providers serving Medicare individual members – Log on to the provider portal and search under Welcome > Provider Reports > Available Reports > Capitation. Providers can also access and view file layouts under Provider Reports > Data File Record Layouts > Seniority Plus.
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.
|
BRM 42 | Expanded Eligibility Report | Lists all members approved by CMS who receive their Medicare Advantage benefits from Health Net. |
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library, located on Health Net’s provider website as listed below.
Additional information
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
Medicare (individual) | 1-800-929-9224 | provider_services@healthnet.com | |
Medicare (employer group) | 1-800-929-9224 | provider_services@healthnet.com |