Primary Care Provider (PCP) Assignment Logic
| Date: | June 10, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan All Capitated Providers |
| Type: | Informational/Educational |
| Subject: | Primary Care Provider (PCP) Assignment Logic |
| Business: | Medi-Cal Managed Care |
HPSJ/MVHP completed our review of the changes impacting PCP capitation and have made all necessary adjustments to the monthly payments. The capitation adjustments will occur starting with your June 2026 capitation payment.
As part of our refinement to the PCP assignment logic, the following member scenarios are not assigned to a PCP:
- Medicare Parts A&B
- Members with Medicare Part B only
- Newborn members in the first 60 days of birth
- Members with other health coverage where HPSJ is secondary. This change will take effect with the July 2026 capitation payment.
In addition, members that lose eligibility and rejoin the Health Plan within 60 calendar days will be automatically assigned back to the last PCP on file, if available.
This refined process improves access for members with primary insurance, and newborns are already covered under mom’s insurance for the month of birth and the month after. In addition, reinstating members back to their previous PCP when regaining eligibility supports continuity of care for members that already have an established relationship with their PCP.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
