July 12, 2024 / by HPSJ / Alerts
Date: July 12, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers Type: Informational Subject: Jiva System Downtime Business: Medi-Cal Managed Care ZeOmega, the organization providing the Jiva platform via the Cloud, will conduct their annual Disaster Recovery (DR) exercise on Saturday, July 13, 2024. During this time, [...]
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Health Plan of San Joaquin provider Alerts
Reminder: Enhanced Provider Dispute Resolution (PDR) Process
July 24, 2024 / by HPSJ / Alerts
Date: July 24, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers and Facilities Type: Educational/ Informational Subject: Reminder: Enhanced Provider Dispute Resolution (PDR) Process Business: Medi-Cal Managed Care On April 15, 2021, Health Plan implemented several new enhancements to the PDR process. This alert serves as a [...]Read more
FDA Drug Recall – Acetaminophen Injection, 1000mg/100mL
July 24, 2024 / by HPSJ / Alerts
Date: July 24, 2024 From: Health Plan Pharmacy Department To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Physicians and Providers Type: Formulary Subject: FDA Drug Recall - Acetaminophen Injection, 1000mg/100mL Business: Medi-Cal Managed Care Health Plan would like to inform you there has been a recent recall on the medication Acetaminophen Injection, [...]Read more
Pregnancy Care Office Visit: Antepartum Initial
July 14, 2024 / by HPSJ / Alerts
Date: July 10, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Obstetric Care Providers Type: Regulatory Subject: Pregnancy Care Office Visit: Antepartum Initial Business: Medi-Cal Managed Care Please review the following Medi-Cal (MCL) billing guidelines for proper claim submission and reimbursement for initial antepartum visits. Pregnancy Care Office [...]Read more
Ultrasound During Pregnancy
July 14, 2024 / by HPSJ / Alerts
Date: July 10, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Obstetric Care Providers and Diagnostic Radiologists Type: Regulatory Subject: Ultrasound During Pregnancy Business: Medi-Cal Managed Care Please review the following Medi-Cal (MCL) billing guidelines for proper claim submission and reimbursement for ultrasound during pregnancy services. Ultrasound During [...]Read more
Medical Benefit Updates
July 14, 2024 / by HPSJ / Alerts
Date: July 10, 2024 From: Health Plan Pharmacy and Therapeutics Committee To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers and Physicians Type: Regulatory Subject: Medical Benefit Updates Business: Medi-Cal Managed Care Effective September 16, 2024, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code J3358 [...]Read more
Update to Changes to Prior Authorization Requirements for Physical Therapy Visits
July 14, 2024 / by HPSJ / Alerts
Date: July 10, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers and Facilities Type: Informational/Regulatory Subject: Update to Changes to Prior Authorization Requirements for Physical Therapy Visits Business: Medi-Cal Managed Care To improve member access to services and provider experience, Health Plan is implementing a change to [...]Read more
Jiva System Downtime
July 12, 2024 / by HPSJ / Alerts
Date: July 12, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers Type: Informational Subject: Jiva System Downtime Business: Medi-Cal Managed Care ZeOmega, the organization providing the Jiva platform via the Cloud, will conduct their annual Disaster Recovery (DR) exercise on Saturday, July 13, 2024. During this time, [...]Read more
The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program – File Reconciliation Update
July 3, 2024 / by HPSJ / Alerts
Date: July 03, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Skilled Nursing Facilities Type: Regulatory Subject: The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program – File Reconciliation Update Business: Medi-Cal Managed Care Health Plan is providing an update on the Department of [...]Read more
Ground Emergency Transportation and Non-Emergency Transportation Billing and Documentation Requirements
June 27, 2024 / by HPSJ / Alerts
Date: June 26, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan) Practitioners and Hospitals Non-Emergency Medical Transportation (NEMT) & Ground Emergency Medical Transportation (GEMT) Type: Regulatory Subject: Ground Emergency Transportation and Non-Emergency Transportation Billing and Documentation Requirements Business: Medi-Cal Managed Care Non-Emergency Medical Transportation (NEMT) Non-Emergency Medical Transportation [...]Read more
Laboratory Test in Hospital and Pathology Billing – Update
June 20, 2024 / by Araceli Gallo / Alerts
Date: June 19, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan) Pathologist/Laboratory Providers & Inpatient/Outpatient Facilities Type: Regulatory Subject: Laboratory Test in Hospital and Pathology Billing - Update Business: Medi-Cal Managed Care Please review the following California Medicaid (MCL) billing guidelines for proper claim submission and reimbursement for pathology [...]Read more