Medicare AdvantageReimbursementMedium impact
20-331 Access 2020 MIPS Payment Adjustment Data Files Online
Health Net·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net has released the 2020 MIPS payment adjustment data file for Participating Physician Groups (PPGs) to calculate proper reimbursement adjustments for Medicare Advantage services provided by non-contracting clinicians. PPGs must access the file online and apply positive MIPS adjustments using specific NPI/TIN matching rules to ensure compliance with Medicare fee-for-service equivalent payments.
Action Required
Immediately: Billing team must access the 2020 MIPS payment adjustment data file at provider.healthnet.com under Working with Health Net > Regulatory > Merit-based Incentive Payment System Program. Match clinician NPI/TIN combinations to the data file and apply appropriate MIPS adjustment percentages to Medicare Advantage claims for non-contracting providers. Document chosen cost-sharing approach (Approach 1 or 2) in billing policies and procedures. Ensure combined payments meet Medicare fee-for-service equivalent amounts.