Annual Provider Network Reporting

Annual Provider Network Report Forms, Grievance Report Forms and Annual Out-Of-Network Payment Report Form for Measurement Year 2018

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.

2018 Annual Provider Network Report Forms

The Department has made changes to the Annual Provider Network Report Forms (previously known as "Timely Access Repot Forms") for Measurement Year 2018 (MY 2018), in accordance with Health and Safety Code section 1367.035, subd. (g). For MY 2018, the Department has added new reporting tabs into the PCP, Specialists, Other Contracted Providers, and Service Area and Enrollment Annual Provider Network Report Forms. Review the instructions for these forms carefully before populating them.

Links to the Annual Provider Network Report Forms for MY 2018 are provided below. The following Report Forms are in a "locked" Excel format. Health plans must use these Report Forms to compile data for each network, as of December 31, 2018. As a reminder, Report Forms are due to the Department no later than March 31, 2019.

Refer to the instructions tab within each MY 2018 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.

2018 Out-Of-Network Payment Report Form (AB 72)

As Required by Health and Safety Code section 1371.31(a)(4), Annual Provider Network Report Forms must also 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 Annual Out-Of-Network Payment Report From for MY 2018 is provided below.

2018 Timely Access and Network Adequacy Grievance Report Form

The link to the Timely Access and Network Adequacy Grievance Report Form for MY 2018 is provided below.

Annual Provider Network Submission Instruction Manual

The Annual Provider Network Submission Instruction Manual for Measurement Year (MY) 2018 contains Frequently Asked Questions (FAQs) and highlights changes to the submission of health plan data for MY 2018.  The Instruction Manual also provides example reporting scenarios including the reporting of plan-to-plan contracts and other arrangements. Plans should continue to refer to the Instructions Tab within each excel Report Form for reporting instructions specific to each field within the Report Forms, and refer to the Instruction Manual for further background information. 

Annual Provider Network Submission Instruction Manual- 12/11/2018

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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