DHCS Value Based Payment

The Department of Health Care Services (DHCS) has advised of their intention to sunset the VBP program effective for dates-of-service after June 30, 2022. Please submit all VBP claims timely. Please click here to learn more.

Health Plan of San Joaquin is excited to partner with you on the DHCS Value Based Payments Program. The Value Based Payment (VBP) Program has been established and funded by DHCS to provide supplemental payments to providers for meeting specific measures aimed at improving care for some of our community’s most vulnerable.

You make a critical impact in our community and we are working to make this program as provider-friendly as possible while working to maximize supplemental payments you receive. Our HPSJ team is happy to assist you or your office with any questions.

Dr. Lakshmi Dhanvanthari, CMO

Value Based Payment Measures

Incentive payments are for VBP measures in the following areas:

Prenatal/Postpartum Care
Early Childhood Prevention
Chronic Disease Management
Behavioral Health Integration

Participation

To qualify for supplemental payment, providers must be practicing within their practice scope and must have an individual (Type 1) National Provider Identifier (NPI). For example, if a pharmacist (not the pharmacy) provides an immunization, then that pharmacist could receive payment. The encounter data is the basis of performance scoring. DHCS will be distributing the VBP funds through HPSJ based on the data they receive.

Eligibility

Exclusions to DHCS VBP program participation criteria include the following:

Providers NOT contracted with Health Plan of San Joaquin
Services for beneficiaries with Medicare Part B will be excluded
Encounters occurring at Federally Qualified Health Centers (FQHCs), Rural Health Clinics, American Indian Health Clinics and Cost Based Reimbursement Clinics will be excluded from VBP payment”

Prepare

Become familiar with ICD-10 codes for “Substance Use Disorder”, “Serious Mental Illness”, “Homelessness”, and “Inadequate Housing” as these codes will be used for “Additional At-Risk Add-On” determination justification.

VBP Training

Please register for one of our DHCS VBP Program webinar based trainings noted on this website panel. If you are unable to participate one of the webinar trainings, please call HPSJ Customer Service at 209.942.6340 to set up a training with an HPSJ Provider Services Representative. We encourage your key team members that assist in billing and coding to attend the training. Note: The webinar session marked “Follow-up” will be an opportunity for providers to seek clarification to questions on the DHCS VBP program, it will not be a comprehensive training. Comprehensive trainings are provided through the webinar sessions noted as “Training”. We look forward to partnering with you on this DHCS program.

Questions?

If you have questions or concerns pertaining to the DHCS VBP program and/or claims you believe qualified for the DHCS VBP program, please contact the HPSJ Claims Department via email at: supplementalpayments@hpsj.com