May 4, 2023 / by Health Plan / Alerts
Date: May 4, 2023 To: Health Plan of San Joaquin (HPSJ) Long-Term-Care Facilities From: HPSJ Type: Regulatory/Informational Subject: Supplemental Payment Business: Medi-Cal Managed Care For 2023, Health Plan of San Joaquin (HPSJ) will continue paying a supplemental payment for the first 45 days of admission. Starting July 5, 2023, to receive this supplemental payment, facilities [...]
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Dual Members: Overpayments
May 30, 2023 / by Health Plan / Alerts
Date: May 30, 2023 To: Health Plan of San Joaquin (HPSJ) Long Term Care Providers From: HPSJ Type: Announcement Subject: Dual Members: Overpayments Business: Medi-Cal Managed Care Medicare/Medi-Cal (Dual) HPSJ Members & Long-Term Care Claims for Medicare/Medi-Cal recipients must first be billed to the appropriate Medicare carrier or intermediary for processing of Medicare benefits. Medi-Cal [...]Read more
Long Term Care – Share of Cost (SOC) Value Codes
May 22, 2023 / by Health Plan / Alerts
Date: May 22, 2023 To: Health Plan of San Joaquin (HPSJ) Providers and Facilities From: HPSJ Type: Regulatory/Informational Subject: Long Term Care – Share of Cost (SOC) Value Codes Business: Medi-Cal Managed Care In accordance with guidelines from the Department of Health Care Services (DHCS), providers may collect Share of Cost (SOC) payments from a [...]Read more
Vendor Update
May 22, 2023 / by Health Plan / Alerts
Date: May 22, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners From: HPSJ Type: Informational Subject: Vendor Update Business: Medi-Cal Managed Care Effective May 1, 2023, HPSJ is no longer offering Diabetes Prevention Program through Melon Health. We apologize to our members who may be impacted by this change. HPSJ is working to find [...]Read more
Clinical Review: Management of Acute Postpartum Pain
May 11, 2023 / by Health Plan / Pharmacy Announcements
Racial and ethnic disparities are prevalent in maternal care, and improving health equity has been identified as a priority focus for the Medi-Cal program. ACOG recommends shared decision-making using a stepwise, multimodal approach that includes acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) as first-line analgesics, especially for individuals who are breastfeeding. If first-line options do not [...]Read more
Supplemental Payment
May 4, 2023 / by Health Plan / Alerts
Date: May 4, 2023 To: Health Plan of San Joaquin (HPSJ) Long-Term-Care Facilities From: HPSJ Type: Regulatory/Informational Subject: Supplemental Payment Business: Medi-Cal Managed Care For 2023, Health Plan of San Joaquin (HPSJ) will continue paying a supplemental payment for the first 45 days of admission. Starting July 5, 2023, to receive this supplemental payment, facilities [...]Read more
Skilled Nursing Facility/Long Term Care Payment Issue
May 4, 2023 / by Health Plan / Alerts
Date: May 4, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Skilled Nursing Facility/Long Term Care From: HPSJ Type: Regulatory/Informational Subject: Skilled Nursing Facility/Long Term Care Payment Issue Business: Medi-Cal Managed Care We regret to inform you that due to a technical issue that occurred on March 31, 2023, some long-term care claims may [...]Read more
UPDATE- Monthly Capitation (CAP) Payment Scheduled for May 2023
May 4, 2023 / by Health Plan / Alerts
Date: May 4, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCP) From: HPSJ Type: Informational/Educational Subject: UPDATE- Monthly Capitation (CAP) Payment Scheduled for May 2023 Business: Medi-Cal Managed Care This notice is to inform you that your May 2023 capitation payment will be delayed. We want you to be aware of [...]Read more
Long Term Care Authorizations Update
March 22, 2023 / by Health Plan / Alerts
Date: March 21, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Skilled Nursing Facility/Long Term Care From: HPSJ Type: Procedural Update Subject: Long Term Care Authorizations Update Business: Medi-Cal Managed Care Effective January 1, 2023, Health Plan of San Joaquin (HPSJ) must authorize and cover medically necessary services provided for members residing in Skilled [...]Read more
Timely Access Survey – Start January 1, 2022
January 5, 2022 / by Health Plan / Alerts
Date: January 5, 2022 To: HPSJ Contracted Provider Network Provider Alert Type: Regulatory/Informational From: Health Plan of San Joaquin Subject: Timely Access Survey - Start January 1, 2022 Business: Medi-Cal The Department of Health Care Services (DHCS) conducts an annual Timely Access Study to monitor member timely access to care. DHCS will start the annual [...]Read more