Health Plan of San Joaquin provider Alerts

Pregnancy Care Office Visit: Antepartum Initial

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 [...]

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Ultrasound During Pregnancy

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 [...]

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Medical Benefit Updates

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 [...]

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Update to Changes to Prior Authorization Requirements for Physical Therapy Visits

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 [...]

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Jiva System Downtime

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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The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program – File Reconciliation Update

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 [...]

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Ground Emergency Transportation and Non-Emergency Transportation Billing and Documentation Requirements

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 [...]

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Laboratory Test in Hospital and Pathology Billing – Update

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 [...]

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Billing Anesthesia Services

Date: June 19, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan) Practitioners and Hospitals Type: Regulatory Subject: Billing Anesthesia Services Business: Medi-Cal Managed Care Billing Anesthesia Services Anesthesia services (CPT codes 00100 through 01999) are reimbursed when medically necessary. To bill for anesthesia services, use the five-digit [...]

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Final Reminder: CalAIM All-Network Training

Date: June 19, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: El Dorado and Alpine County Providers Type: Informational/ Educational Subject: Final Reminder: CalAIM All-Network Training Business: Medi-Cal Managed Care This alert is a reminder. Please join us for a CalAIM All-Network Training on the date listed below. Health Plan [...]

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