Medicare AdvantageReimbursementMedium impact
21-164 Access the 2021 MIPS Payment Adjustment Data Files Online
Health Net·CA·Reimbursement
Effective date
Jan 28, 2021
We identified it
Jun 20, 2026
Summary
Health Net has delayed the 2021 MIPS payment adjustment start date from January 1 to January 28, 2021, for Medicare Advantage out-of-network claims. Participating physician groups must now use the updated MIPS data file to calculate proper payment adjustments for noncontracted providers within the 30-day prompt payment window.
Action Required
By January 28, 2021: Billing team must access the updated 2021 MIPS data file from Health Net provider website under Working with Health Net > Regulatory > Merit-based Incentive Payment System Program. Update payment calculation procedures to match clinician TIN/NPI combinations with the MIPS data file and apply positive adjustment percentages for out-of-network Medicare Advantage claims. Document chosen cost-sharing approach (Health Net uses Approach 2) in policies and procedures.