24-647m Enhanced ACE_78A and ACE_78B Reports Incorporate Supplemental Adjustment Totals
Date: 06/26/24
Reports now capture Supplemental Adjustments in addition to the capitation dollars to help create more transparency with providers
Health Net has made enhancements to the ACE_78A and ACE_78B reports to add "Supplemental Adjustments," known as supplementals, to be reported in addition to their capitation dollars. Some examples include but are not limited to the Professional Performance Program (PPP), Shared Risk Funding (SRF) and Utilization Management (UMD). These Supplemental Adjustments are now incorporated into the report.
Codes vary, and these reports are available to providers contracted for any of these programs. All participating physician groups (PPGs) receive the reports on a monthly basis. Now, in addition to capitation totals, PPGs will receive supplemental financial totals for the current month, retroactive months and year-to-date. Code examples are included below:
Commercial codes
- PCA – Provider Cap Adjustment
- PPP – Professional Performance Program
- SRF – Shared Risk Funding
- UMD – Utilization Management
- IPP – Institutional Performance Program
Medi-Cal codes
- AFP – Access to Care Fund
- AWP – Access to Care Withhold
- CCF – Care Coordination Fee
- CMP – Choice Member Increase
- EFP – Encounter Submission Fund
- ESP – Encounter Submission Standards
- HQP – HEDIS® Quality Performance
- MDP – Medical/Dental Membership Crossover
- MRP – Membership Retention Increase
- QFP – HEDIS Quality Fund
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone or through the Health Net provider portal.
Line of business | Phone number | Email address |
|---|---|---|
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
Medi-Cal (including CS and ECM providers) | N/A |
This information applies to Hospitals and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, including Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.