Medicare AdvantageReimbursementMedium impact
20-924 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 participating physician groups (PPGs) to pay noncontracted MIPS-eligible clinicians the full Medicare fee-for-service amount plus positive MIPS adjustments (7% for 2021, 9% for 2022+) within 30 days for Medicare Advantage services. PPGs 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 clinician NPI/TIN combinations to apply correct MIPS adjustment percentages (7% for 2021, 9% for 2022+). Update payment processing workflows to ensure noncontracted MIPS-eligible providers receive full payments within 30 days. Document chosen cost-sharing approach (Approach 1 or 2) in policies and procedures. Apply adjustments either at time of payment or as retroactive adjustments with proper notice to clinicians.