Medicare AdvantageReimbursementMedium impact
21-163 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 updated the 2021 MIPS payment adjustment start date from January 1 to January 28, 2021, for participating physician groups processing out-of-network Medicare Advantage claims. PPGs must access the updated MIPS data file and apply positive payment adjustments to noncontracted providers within 30 days of receiving clean claims.
Action Required
Immediately: Billing team must access the 2021 MIPS data file from Health Net provider website under Working with Health Net > Regulatory > Merit-based Incentive Payment System Program. Update payment calculations for out-of-network Medicare Advantage claims to match clinician TIN/NPI combinations with MIPS adjustment percentages. Apply positive adjustments only (negative adjustments are optional). Ensure combined payments to noncontracted clinicians equal MIPS-adjusted Medicare fee-for-service amounts within 30-day prompt payment window.