After Hours Survey is Here
| Date: | November 6, 2024 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) |
| To: | Health Plan Providers and Practitioners |
| Type: | Regulatory |
| Subject: | Claims Editing System (CES)- Quarterly Update |
| Business: | Medi-Cal Managed Care |
The Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) require that providers have 24 hours, 7 days a week access for Health Plan members. A key goal for Health Plan is to ensure that our members have emergency instructions and after-hours access to care.
To ensure that providers are in compliance with after-hours emergency instructions and member access to care, Health Plan has contracted a vendor to conduct an after-hours survey as part of monitoring. The telephonic survey will begin this week and will conclude by the end of December 2024.
In order to ensure that providers are compliant with the required access standards, all four requirements listed below should be met. Please review your after-hours messaging, and if applicable, make necessary updates to ensure it meets the requirements.
| After-Hours Access Survey Requirements |
| 1. Is the practitioner’s recorded message or live attendant available 24-hours, 7 days a week? |
| 2. Are emergency instructions to call 911 or go to the nearest emergency room provided on a recorded message or by a live person? |
| 3. Is there an on-call provider available for urgent care by transferring the call or providing information on how to reach an on-call provider to triage or screen by phone? |
| 4. If the member is required to leave a message, does the recorded message or live attendant state the return call would be within 30 minutes?
Note: Return call to triage or screen by phone should be within 30 minutes. |
We thank you for ensuring that Health Plan members have access to after-hours care.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-7526 (PLAN). 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
