October 30, 2024 / by Health Plan / Alerts
Date: October 30, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers, Practitioners, and Facilities Type: Procedural Update Subject: Retrospective Review Update Business: Medi-Cal Managed Care Health Plan has made some adjustments to the Retrospective Review Protocol to ensure our members receive care without delay. The protocol listed [...]
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Claims Editing System (CES)- Quarterly Update
November 11, 2024 / by Health Plan / Alerts
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 Effective November 22, 2024. Health Plan will implement a quarterly update to the Claims Editing System (CES) to align with the [...]Read more
Cultural and Linguistic Service Updates
November 11, 2024 / by Health Plan / Alerts
Date: November 6, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers, Specialists, Hospitals and Facilities Type: Regulatory Subject: Cultural and Linguistic Service Updates Business: Medi-Cal Managed Care The Cultural and Linguistic Services department of Health Plan would like to ensure you have qualified interpreter services for members [...]Read more
Lead Screening in Children (LSC)
November 11, 2024 / by Health Plan / Alerts
Date: November 6, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Pediatrics and Primary Care Providers Type: Educational/Informational Subject: Lead Screening in Children (LSC) Business: Medi-Cal Managed Care Healthcare Effectiveness Data and Information Set (HEDIS) Lead Screening in Children (LSC) The Department of Health Services APL 20-016: Blood [...]Read more
Changes to PCP Capitation Rates- Effective December 1, 2024
November 1, 2024 / by Health Plan / Alerts
Date: November 1, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: All Health Plan Providers Type: Regulatory Subject: Changes to PCP Capitation Rates - Effective December 1, 2024 Business: Medi-Cal Managed Care Health Plan is introducing new Primary Care Provider (PCP) capitation payment rates effective December 1, 2024. Below is [...]Read more
Retrospective Review Update
October 30, 2024 / by Health Plan / Alerts
Date: October 30, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers, Practitioners, and Facilities Type: Procedural Update Subject: Retrospective Review Update Business: Medi-Cal Managed Care Health Plan has made some adjustments to the Retrospective Review Protocol to ensure our members receive care without delay. The protocol listed [...]Read more
Case Management referral through New Medical Management System (Jiva)
October 28, 2024 / by Health Plan / Alerts
Date: October 23, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: All Health Plan Providers, Practitioners, and Facilities Type: Informational Subject: Case Management referral through New Medical Management System (Jiva) Business: Medi-Cal Managed Care Health Plan’s Case Management (CM) department has moved to a new medical management system (Jiva) as [...]Read more
Chlamydia Screening in Women (CHL) – HEDIS Measure 2024
October 17, 2024 / by Health Plan / Alerts
Date: October 16, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Contracted PCP's & OB/GYN Offices Type: Educational/Informational Subject: Chlamydia Screening in Women (CHL) - HEDIS Measure 2024 Business: Medi-Cal Managed Care Healthcare Effectiveness Data Information Set (HEDIS) Chlamydia Screening (CHL) Members assigned female at birth ages 16 [...]Read more
Reminder- Collecting Social Determinants of Health (SDOH) Data
October 17, 2024 / by Health Plan / Alerts
Date: October 16, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Primary Care Physicians Type: Educational/Informational Subject: Reminder- Collecting Social Determinants of Health (SDOH) Data Business: Medi-Cal Managed Care As part of the Department of Health Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiative introduced in 2019, [...]Read more
Breast Cancer Screening (BCS-E) and Cervical Cancer Screening (CCS) – Measurement Year 2024 HEDIS
October 17, 2024 / by Health Plan / Alerts
Date: October 16, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan PCP's & OBGYN Type: Educational/Informational Subject: Breast Cancer Screening (BCS-E) and Cervical Cancer Screening (CCS) – Measurement Year 2024 HEDIS Business: Medi-Cal Managed Care Measurement Year 2024 Healthcare Effectiveness Data Information Set (HEDIS) BCS-E - Breast Cancer [...]Read more
Screening, Diagnosis, and Treatment of Chronic Hepatitis C Virus Infection
October 16, 2024 / by Health Plan / Pharmacy Announcements
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