CommercialAdministrativeMedium impact
20-178 Patient Assessment Form No Longer Needed to Get Incentive
Health Net·CA · Family Medicine, Internal Medicine, General Practice·Reimbursement
We identified it
Jun 20, 2026
Summary
CommunityCare participating physician groups (PPGs) no longer need to submit Patient Assessment Forms for the Medical Loss Ratio Incentive Program. Health Net will now calculate incentives automatically based on paid claims from annual wellness visits using specific CPT codes and ICD-10 diagnosis codes.
Action Required
Immediately: Stop submitting Patient Assessment Forms for CommunityCare MLR Incentive Program. Ensure annual wellness visits are coded with qualifying CPT codes (9938X, 9939X series or 99213-99215, 99203-99205) along with lipids panel (80061) and appropriate ICD-10 diagnosis codes (Z00.00, Z00.5, etc.). Verify claims are submitted properly to automatically qualify for incentives.