24-648m 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, on behalf of Community Health Plan of Imperial Valley, 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:
- 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 Community Health Plan of Imperial Valley at 833-236-4141.
This information applies to Hospitals and Participating Physician Groups (PPGs).
This information applies to Medi-Cal in Imperial county.