MedicaidAdministrativeMedium impact
22-614 Simplified Capitation Eligibility Report
Health Net·CA·Pharmacy
Effective date
Jun 1, 2022
We identified it
Jun 20, 2026
Summary
HealthNet California has simplified the Capitation Eligibility Report (BRM 42) for Medi-Cal providers in Fresno, Kings, and Madera counties by removing other health coverage (OHC) information for Medicare Part D, vision, dental, and commercial pharmacy plans. The policy provides updated guidance on how to access reports through the Provider Portal and handle claims when other health coverage is present.
Action Required
Billing team should access updated eligibility reports through the Provider Portal at Healthnet.com and review the simplified format. When processing Medi-Cal claims with OHC codes other than 'A' or 'N', do not process unless proof of payment exhaustion is provided. For OHC code 'F' (Medicare Part C), process with Medicare as primary. Include updated OHC information in encounter reporting submissions.