February 7, 2024 / by Health Plan / Alerts
Date: February 07, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Pharmacy and Therapeutics Committee To: Physicians and Providers Type: Formulary Subject: Medi-Cal Benefit Updates Business: Medi-Cal Managed Care Effective March 25, 2024, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code J1726 - INJECTION, [...]
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HPSJ 2022-2023 Encounter Data Validation Study
February 22, 2024 / by Health Plan / Alerts
Date: February 21, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Provider Network Type: Informational Subject: HPSJ 2022-2023 Encounter Data Validation Study Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) contracts with Health Services Advisory Group (HSAG) annually to conduct an Encounter Data Validation (EDV) [...]Read more
New Place of Service (POS) Code 27 for Street Medicine
February 22, 2024 / by Health Plan / Alerts
Date: February 21, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Provider Network Type: Regulatory Subject: New Place of Service (POS) Code 27 for Street Medicine Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) recently announced that effective for dates of services on or after [...]Read more
Update – Dual Branded Member ID Card
February 22, 2024 / by Health Plan / Alerts
Date: February 16, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Provider Network Type: Informational Subject: Update - Dual Branded Member ID Card Business: Medi-Cal Managed Care Health Plan expanded its operations effective January 1, 2024. As a result, member identification (ID) cards have been updated to include [...]Read more
CalAIM Population Health Management – Transition Care Services
February 16, 2024 / by Health Plan / Alerts
Date: February 14, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Primary Care Providers (PCPs), Specialists, Hospitals and Facilities Type: Regulatory Subject: CalAIM Population Health Management – Transition Care Services Business: Medi-Cal Managed Care Health Plan would like to remind providers that Enhanced Care Management Services includes coordination [...]Read more
New Claims Processes
February 13, 2024 / by Health Plan / Alerts
Date: February 12, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Claims Department To: Health Plan Providers Type: Informational Subject: New Claims Processes Business: Medi-Cal Managed Care Health Plan is implementing two new claims management processes on April 1, 2024, to support automated application of correct coding principles. Claims Pre-payment Processing [...]Read more
Training for New Electronic Medical Management System Coming Soon
February 12, 2024 / by Health Plan / Alerts
Date: February 12, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Network Type: Informational/Event Subject: Training for New Electronic Medical Management System Coming Soon Business: Medi-Cal Managed Care Health Plan is proud to announce that our DRE provider portal will be updated to include a new electronic medical [...]Read more
Medi-Cal Benefit Updates
February 7, 2024 / by Health Plan / Alerts
Date: February 07, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Pharmacy and Therapeutics Committee To: Physicians and Providers Type: Formulary Subject: Medi-Cal Benefit Updates Business: Medi-Cal Managed Care Effective March 25, 2024, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code J1726 - INJECTION, [...]Read more
NAMI San Joaquin County Provider Education Program
February 5, 2024 / by Health Plan / Alerts
Date: February 05, 2024 To: Health Plan Provider Network Type: Informal/Event Subject: NAMI San Joaquin County Provider Education Program Business: Medi-Cal Managed Care The National Alliance on Mental Illness (NAMI) San Joaquin County is hosting a Provider Education Program that begins on February 5, 2024. This five-session course offers a comprehensive view of the experiences [...]Read more
Dured Alternatives to Diphenhydramine for Older Adults
February 5, 2024 / by Health Plan / Pharmacy Announcements
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Retrospective Review Process
January 24, 2024 / by Health Plan / Alerts
Date: January 10, 2024 To: Health Plan Practitioners and Facilities Type: Regulatory Subject: Retrospective Review Process Business: Medi-Cal Managed Care Effective January 1, 2024, DHCS requires all Managed Care Plans to have a retrospective review process that allows providers to submit requests for care provided without prior authorization. Health Plan has established the protocol below [...]Read more