CurrentHealth NetPolicy N/A

Doula provider incentive program

Defines eligibility, timeline, measures, and payment criteria for doula providers to earn incentive payments for improving member outcomes for Medi‑Cal enrollees served by Health Net/Community Health Plan of Imperial Valley.

Policy Summary

PayerHealth Net

PolicyDoula provider incentive program

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionContract directly with the Plan as a participating doula provider, be in good standing, and have capacity to accept new Plan Medi‑Cal enrollees.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2025measurement year for member services

Oct 31, 2026payment date for earned incentives

$50incentive amount per compliant member

>=50%target compliance threshold

$0payment when target < threshold

Doula Incentive Eligibility Criteria

Doula incentive criteria

Criteria to earn doula provider incentives for measurement year 2025

Eligibility

Be in good standing with the Plan
Contract directly with the Plan as a doula participating provider
Openly accept and have the capacity to serve new Plan Medi‑Cal enrollees eligible for doula services

Measurement window

Members serviced between Jan 1, 2025 and Dec 31, 2025 are eligible for incentives

Policy Summary

PayerHealth Net

PolicyDoula provider incentive program

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionContract directly with the Plan as a participating doula provider, be in good standing, and have capacity to accept new Plan Medi‑Cal enrollees.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Measurement and payment rules

A serviced member is an eligible member who has received a service, and the Plan has received a claim or encounter.
Timeliness of Prenatal Care measure
- >= 50% of members serviced are compliant with Timeliness of Prenatal Care measure
- If target met (>= 50%), incentive amount = $50 per compliant member (per measure)
- If target not met (< 50%), incentive amount = $0 per member
Postpartum Care measure
- >= 50% of members serviced are compliant with Postpartum Care measure
- If target met (>= 50%), incentive amount = $50 per compliant member (per measure)
- If target not met (< 50%), incentive amount = $0 per member

Program alignment

Payments from the doula provider incentive align with state requirements for the doula benefit and program
Payments earned are not tied to a direct Provider Participation Agreement with Health Net or Community Health Plan of Imperial Valley, nor to an agreement as a subcontractor with a participating physician group (PPG) or medical group

Incentive Payment Basis & Compliance Targets

Incentive payment basismixed

Incentive tied to reported claims or encounters for serviced members; specific CPT/HCPCS codes not listed in document.

Compliance target

Compliance target>= 50% of members serviced compliant with each measure to earn $50 per member

Payment when target met$50 per member serviced within measurement year for each measure when target >= 50%

Payment when target not met$0 per member serviced within measurement year when target < 50%

Measures coveredTimeliness of Prenatal Care and Postpartum Care

Provider Enrollment and Participation Requirements

Prior Authorization

Eligibility: Contracting, standing, and capacity

To earn doula provider incentives, the provider must be in good standing with the Plan, have a direct contract with the Plan as a doula participating provider, and openly accept and have capacity to serve new Plan Medi‑Cal enrollees eligible for doula services.

Be in good standing with the Plan.
Contract directly with the Plan as a doula participating provider.
Openly accept and have the capacity to serve new Plan Medi‑Cal enrollees eligible for doula services.

Key Definitions

Serviced member

DefinitionA serviced member is an eligible member who has received a service, and the Plan has received a claim or encounter.

Evidence of serviceMust have a claim or encounter recorded by the Plan within the measurement year

Measurement windowMembers serviced within the measurement year (services reported for 2025) are evaluated for compliance