Medicare AdvantageReimbursementMedium impact
24-194 Access the 2024 MIPS Payment Adjustment Data Files Online
Health Net·CA·Reimbursement
Effective date
Feb 2, 2024
We identified it
Jun 20, 2026
Summary
CMS revised the 2024 MIPS payment adjustment start date to February 2, 2024, and Health Net has published guidelines for calculating MIPS-adjusted payments for noncontracted providers. Participating Physician Groups must use the new MIPS data file to apply positive adjustments (up to 9%) when paying out-of-network Medicare Advantage claims within 30 days.
Action Required
Immediately: Billing team must access the 2024 MIPS data file through Health Net's provider portal and update payment calculation procedures for noncontracted providers. Log into Healthnet.com, navigate to Working with Health Net > Regulatory > Medicare Information > Merit-based Incentives Payment System Program to download the data file. Update billing system workflows to match TIN/NPI combinations and apply positive MIPS adjustments (up to 9%) for Medicare Advantage out-of-network claims. Document chosen cost-sharing approach in policies and procedures.