Medicare AdvantageReimbursementMedium impact
20-925 Updates to the 2021 MIPS Payment Year Adjustment Requirements
Health Net·CA·Reimbursement
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net now requires full payment to noncontracted MIPS-eligible clinicians within 30 days for Medicare Advantage services, including positive MIPS adjustments of up to 7% for 2021 and 9% for 2022+. Billing teams must use CMS MIPS data files to match NPI/TIN combinations and calculate proper payment amounts.
Action Required
Immediately: Billing team must access MIPS data file from Health Net provider website under Working with Health Net > Regulatory > Merit-based Incentive Payment System Program. Match billing NPI/TIN combinations to MIPS file and apply adjustment percentages (7% for 2021, 9% for 2022+). Ensure noncontracted MIPS-eligible clinicians receive full adjusted payments within 30 days. Calculate member cost-sharing using Approach 2 (percentage of Medicare physician fee schedule allowed amount). Document chosen approach in policies and procedures.