21-537 Commercial Capitation Eligibility Report Changes
Date: 07/23/21
This information applies to Participating Physician Groups (PPGs) and Hospitals.
File size increasing to 512 bytes
Effective with the October 2021 report, Health Net is adding new fields to the commercial Eligibility Report (BRM 42) for capitated/delegated participating physician groups (PPGs) and hospitals.
Changes to the Eligibility Report (BRM 42) are as follows:
- Health Net is adding new fields for other health coverage (OHC) information. Commercial PPGs and hospitals will see all the new fields when data is available, but the OHC_CODES fields will always be blank.
- As a result of the change, the file size is increasing from the current 400 bytes to 512 bytes.
For monthly reports, log into the provider portal under Provider Reports > Available Reports. Providers can also access and view file layouts under Provider Reports > Data File Record Layouts.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center within 60 days, by telephone or through the Health Net provider website as listed below.
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
EnhancedCare PPO (IFP) | 1-844-463-8188 |
| |
EnhancedCare PPO (SBG) | 1-844-463-8188 |
| |
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 |
| |
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 |
|