April 2019 – Claims corner newsletter

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Offset/Recoupments (Provider Alert 5.16.18)

Offsetting Against Future Claims

If the provider has not reimbursed HPSJ for the overpayment within sixty (60) days from the date it receives the written notice of HPSJ’s identified overpayment, or denial of written dispute, then HPSJ will provide written notice of the intent to offset. * HPSJ has also extended the option for the provider to elect to have overpayment (s) repaid through the “offset” process, and avoid paying by check by submitting the Offset Request Form.


Temporary New Mailing Address (Provider Alert 3. 6.19)

Health Plan of San Joaquin (HPSJ) will have a new mailing address for initial and corrected paper claim(s) submission. Effective May 15, 2019 all paper claim submissions should be mailed to the following address,until further notice:

Health Plan of San Joaquin (HPSJ)
Attention: Claims Department
P.O. Box 30490
Stockton, CA 95213-30490

Reminder: All claims should be submitted electronically unless
required documentation is needed to process claim.


Provider Disputes (PDR) Submission

Ability to Submit Provider Disputes (PDR) online/DRE (Provider Alert 07.02.15)
Please remember to submit provider disputes (PDR) through the online provider portal (DRE). The submission online will streamline the PDR process. It is not necessary to submit a “second level appeal” through the mail. The ability to upload any necessary documents is available as well. *Only submit documentation to support denied services. We will not review and will send back excessive documentation and will only cause a delay in processing.


Final

If you do not agree with HPSJ’s final determination you have the right to appeal directly to the California Department of Social Services (State Hearing division) within 60 business days of the determination letter.

Posted on May 1st, 2019 and last modified on May 1st, 2019.

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