Health Plan of San Joaquin provider Alerts

Formulary Update – September 18, 2019

Date: September 18, 2019 To: Health Plan of San Joaquin (HPSJ) Physicians, Providers, and Pharmacies From: Health Plan of San Joaquin Pharmacy and Therapeutics Committee Subject: Formulary Update – September 18, 2019 Business: Medi-Cal Managed Care Effective 12/02/2019, the Pharmacy and Therapeutics Committee has approved the following changes: Additions to the Formulary: Heparin sodium porcine/PF […]

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Update for HPSJ Member Incentives

Date: September 18, 2019 To: Health Plan of San Joaquin (HPSJ) Practitioners, Providers, and Facilities From: HPSJ Quality Management Department Subject: Update for HPSJ Member Incentives Business: Medi-Cal Managed Care Effective date for this Incentive Texting/Online Pilot is October 2019, pending DHCS approval. HPSJ has made several key changes to the member incentives program. The […]

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Clinical Review Update: Concomitant Anticholinergic and Antipsychotic Use

Learning Objectives: Understand the role of anticholinergic medications in the prevention and treatment of antipsychotic-induced extrapyramidal symptoms (EPS). Describe factors that should be considered when deciding to initiate and/or continue the concomitant use of anticholinergic with antipsychotic medication therapy. Key Points: Anticholinergic medications, including benztropine and trihexyphenidyl, are often prescribed to prevent or treat antipsychotic-induced […]

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Paper Claims Submission – Address Change

Date: September 5, 2019 To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities From: HPSJ Claims Department Subject: Paper Claims Submission – Address Change Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) will have a new mailing address for initial and corrected paper claim(s) submissions. Effective October 1, 2019 all paper […]

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**Reminder** Provider Dispute Resolution (PDR) Submission

Date: September 4, 2019 To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities From: HPSJ Claims Department Subject: **Reminder** Provider Dispute Resolution (PDR) Submission Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) would like to remind providers and facilities of proper protocol for submitting Provider Dispute Resolutions (PDRs). Contracted Providers must […]

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HEDIS Training Breakfast & Learn

Date: August 5, 2019 To: Health Plan of San Joaquin (HPSJ) Network: PCP, OB/GYN, Behavioral Health From: HPSJ Provider Services Department Subject: HEDIS Training BREAKFAST & LEARN – Practical Tips for Your Success This Year Our HPSJ providers are essential partners in delivering care to our members. Because of your valued contributions, we are glad […]

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DHCS Encounter Requirement – NDC Required

Date: August 5, 2019 To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities From: HPSJ Claims Department Subject: DHCS Encounter Requirement – NDC Required    Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) was recently informed the California Department of Health Care Services (DHCS) is requiring the National Drug Code (NDC) […]

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CMS-Required Fraud, Waste, and Abuse (FWA) Training for HPSJ Providers

Date: July 24, 2019 To: Health Plan of San Joaquin (HPSJ) Providers  From: HPSJ Provider Networks Department Subject: CMS-Required Fraud, Waste, and Abuse (FWA) Training for HPSJ Providers Business: Medi-Cal Health Plan of San Joaquin, as a licensed health care services plan regulated by the Department of Managed Health Care (DMHC) and contracted with the […]

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Pediatric Palliative Care

Date: July 11, 2019 To: Health Plan of San Joaquin (HPSJ) Providers From: HPSJ Medical Management Department Subject: Pediatric Palliative Care Business: Medi-Cal Medi-Cal plans are required to provide palliative care services to their pediatric members (APL 18-020). A member under 21 years of age can receive palliative care and hospice services concurrently with curative […]

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Important Information: HEDIS Tip Sheet, G0447

Date: July 11, 2019 To: All Health Plan of San Joaquin (HPSJ) Contracted Providers, Facilities, and Ancillary Services From: HPSJ Quality Management Department Subject: Important Information: HEDIS Tip Sheet, G0447 Business: Medi-Cal The annual HEDIS Provider Tip Sheet is a tool used to inform providers of the value set codes published at the national level […]

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