MedicaidAdministrativeMedium impact
22-613 Simplified Capitation Eligibility Report
Health Net·CA·Pharmacy
Effective date
Jun 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net has simplified their Eligibility Report (BRM 42) for capitated physician groups and hospitals by removing other health coverage (OHC) information including Medicare Part D, vision plans, dental policies, and commercial pharmacy plans. The policy also clarifies how to handle OHC claims processing and where to find carrier information.
Action Required
Immediately: Billing team must update eligibility verification workflows to access OHC carrier contact information from record type 3 section at bottom of eligibility reports instead of removed fields. Update staff training on new FAQ guidelines for processing Medi-Cal claims with OHC codes other than 'A' or 'N' - these should be contested for OHC unless proof of payment exhaustion is provided. Access updated eligibility reports through Provider Portal at Healthnet.com under Provider Reports section.