Annual Provider Network Reporting

Annual Provider Network Report Forms, Grievance Report Forms and Annual Out-Of-Network Payment Report Form for Measurement Year 2017

Pursuant to California Code of Regulations, title 28, section 1300.67.2.2, subd. (g)(2)(G) and Health and Safety Code sections 1367.03, subd. (f)(2), 1367.035 & 1371.31, subd. (a)(4), by March 31, 2012, and by March 31 of each year thereafter, all full service and mental health plans are required to submit provider network reports, timely access and network adequacy grievance reports and out-of-network payment reports to the DMHC.

2017 Annual Provider Network Report Forms

The DMHC has made changes to the Annual Provider Network Report Forms (previously known as "Timely Access Report Forms") for Measurement Year 2017 (MY 2017).

Links to the Annual Provider Network Report Forms for MY 2017 are provided below. The following Report Forms are in a "locked" Excel format. Health plans must use these Forms to compile data for each network, as of December 31, 2017. As a reminder, Report Forms are due to the Department no later than March 31, 2018.

Please refer to the instructions tab within each MY 2017 Report Form template for directions on completion of the template. Please contact the Department with any reporting questions prior to the date for submission of Annual Provider Network Report Forms.

2017 Out-Of-Network Payment Report Form (AB 72)

As required by AB 72 (see Health and Safety Code section 1371.31(a)(4)), Annual Provider Network Report Forms for MY 2017 now include the Annual Out-Of-Network Payment Report Form, which is due the same day as the other Annual Provider Network Report Forms linked above. The link to the Out-Of-Network Payment Report Form for MY 2017 is provided below.

2017 Timely Access and Network Adequacy Grievance Report Form

The link to the Timely Access and Network Adequacy Grievance Report Form for MY 2017 is provided below.

2017 Annual Provider Network Submission Instruction Manual

In addition to the Instructions tab within each MY 2017 Report Form, further background instructions are available below in the MY 2017 Annual Provider Network Submission Instruction Manual. The Manual addresses Frequently Asked Questions, lists changes to the Report Form templates from previous measurement years and provides example reporting scenarios. The Manual also addresses questions that were raised during health plan workgroup meetings in 2017 and during educational Webinars hosted by the Department on December 11th and 13th of 2017. Please see the MY 2017 Instruction Manual link below. The manual was originally uploaded on January 4, 2018, and an updated version was posted as of January 26, 2018.

MY 2017 Instruction Manual - 1/26/2018

2017 Clarifications Grid

In addition to the Instructions tab within each MY 2017 Report Form and the MY 2017 Annual Provider Network Submission Instruction Manual, the MY 2017 Clarifications Grid provides responses to questions recently sent to the Department regarding the MY 2017 Annual Provider Network Reporting. The MY 2017 Clarifications Grid will be updated on a weekly basis. The link to the MY 2017 Clarifications Grid is provided below.

MY 2017 Clarifications Grid - Updated as of 4/10/2018

2017 Educational Webinar 

The link below is the PowerPoint the Department used in the MY 2017 Annual Network Review Educational Webinar which took place on December 11th and 13th of 2017.

Related Annual Network Report Form Links

Sections 1367.03 and 1367.035 of the California Health and Safety Code

Section 1300.67.2.2 in Title 28 of the California Code of Regulations

List of Licensed Health Plans

Annual Network Report Form Archive

To view previously issued report forms, instructions, and other reference material for annual network review reports please see the:

Annual Network Review Reports Archive

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