Medicare AdvantageDocumentationHigh impact
26-758m Meet TRC and FMC Requirements: Required Documentation and Timelines
Health Net·CA·Reimbursement
We identified it
Jun 30, 2026
Summary
Health Net California has released a new policy requiring providers to use the TRC and FMC Provider Checklist to ensure compliance with Transitions of Care (TRC) and Follow-Up After Emergency Department Visit (FMC) documentation and reporting standards. Providers must incorporate this checklist into workflows to maintain timely post-discharge and post-ED follow-up documentation, meet required timelines, and support accurate HEDIS measure reporting.
Action Required
IMMEDIATELY: All providers and billing staff must obtain and review the TRC and FMC Provider Checklist from the Health Net California provider library under 'HEDIS Measures & Billing Codes' > 'Hospital Follow Up' section. Incorporate the checklist into clinical and billing workflows to: (1) Ensure qualifying TRC and FMC services are completed within required timelines; (2) Maintain complete and compliant documentation per plan requirements; (3) Verify accurate measure reporting and submission. Billing team must update internal processes to validate that all post-discharge and post-emergency department follow-up visits are documented and submitted in accordance with the checklist requirements. Providers are responsible for compliance; failure to meet documentation and timeline requirements will result in measure compliance failures and potential claim denials or reimbursement adjustments.