Skilled Nurse Facilities (SNF) / Long Term Care (LTC) Erroneous Denials

Date: October 04, 2023 To: Health Plan of San Joaquin (HPSJ) All Providers and Facilities Type: Regulatory/Informational Subject: Skilled Nurse Facilities (SNF)/ Long Term Care (LTC) Erroneous Denials Business: Medi-Cal Managed Care HPSJ has identified an issue where denial notices were incorrectly issued for “admission date is greater than the statement through date” for all [...]

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Medical Benefits Updates

Date: October 03, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers Type: Formulary Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective December 11, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code J2327 – INJECTION, RISANKIZUMAB-RZAA, (SKYRIZI), 1 MG: For Acute and Chronic [...]

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Health Plan of San Joaquin (HPSJ) Helps Fund Multi-purpose Center that Provides Services to Unsheltered Community in Stockton

(French Camp, CA) - Health Plan San Joaquin (HPSJ) committed $3,000,000 in funding to Gospel Center Rescue Mission’s New Life Multi-Purpose Center located in Downtown Stockton. The funding is in addition to commitments from other partners that will expand recuperative care services for unsheltered residents of our community. The project will involve multiple construction phases [...]

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Place of Service Billing for Services in FQHCs and RHCs

Date: September 27, 2023 To: Health Plan of San Joaquin (HPSJ) Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) From: Health Plan of San Joaquin (HPSJ) Type: Regulatory Subject: Place of Service Billing for Services in FQHCs and RHCs Business: Medi-Cal Managed Care Effective December 1, 2023, claims for payment of services that [...]

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Look and Learn – New HEDIS Portal – Inovalon – Training

Date: September 22, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCPs), Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) From: Health Plan of San Joaquin (HPSJ) Type: Event/Informational Subject: Look and Learn – New HEDIS Portal – Inovalon – Training Business: Medi-Cal Managed Care Health Plan of San Joaquin [...]

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DHCS Equity and Practice Transformation Payments Program

Date: September 11, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Provider Organizations From: Health Plan of San Joaquin (HPSJ) Type: Informational Subject: DHCS Equity and Practice Transformation Payments Program Business: Medi-Cal Managed Care On August 30, the California Department of Health Care Services (DHCS) launched the Equity and Practice Transformation (EPT) Provider [...]

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