October 30, 2024 / by Health Plan / Alerts
Date: October 30, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers, Practitioners, and Facilities Type: Procedural Update Subject: Retrospective Review Update Business: Medi-Cal Managed Care Health Plan has made some adjustments to the Retrospective Review Protocol to ensure our members receive care without delay. The protocol listed [...]
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Health Plan of San Joaquin provider Alerts
Lead Screening in Children (LSC)
November 11, 2024 / by Health Plan / Alerts
Date: November 6, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Pediatrics and Primary Care Providers Type: Educational/Informational Subject: Lead Screening in Children (LSC) Business: Medi-Cal Managed Care Healthcare Effectiveness Data and Information Set (HEDIS) Lead Screening in Children (LSC) The Department of Health Services APL 20-016: Blood [...]Read more
Changes to PCP Capitation Rates- Effective December 1, 2024
November 1, 2024 / by Health Plan / Alerts
Date: November 1, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: All Health Plan Providers Type: Regulatory Subject: Changes to PCP Capitation Rates - Effective December 1, 2024 Business: Medi-Cal Managed Care Health Plan is introducing new Primary Care Provider (PCP) capitation payment rates effective December 1, 2024. Below is [...]Read more
Retrospective Review Update
October 30, 2024 / by Health Plan / Alerts
Date: October 30, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers, Practitioners, and Facilities Type: Procedural Update Subject: Retrospective Review Update Business: Medi-Cal Managed Care Health Plan has made some adjustments to the Retrospective Review Protocol to ensure our members receive care without delay. The protocol listed [...]Read more
Case Management referral through New Medical Management System (Jiva)
October 28, 2024 / by Health Plan / Alerts
Date: October 23, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: All Health Plan Providers, Practitioners, and Facilities Type: Informational Subject: Case Management referral through New Medical Management System (Jiva) Business: Medi-Cal Managed Care Health Plan’s Case Management (CM) department has moved to a new medical management system (Jiva) as [...]Read more
Chlamydia Screening in Women (CHL) – HEDIS Measure 2024
October 17, 2024 / by Health Plan / Alerts
Date: October 16, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Contracted PCP's & OB/GYN Offices Type: Educational/Informational Subject: Chlamydia Screening in Women (CHL) - HEDIS Measure 2024 Business: Medi-Cal Managed Care Healthcare Effectiveness Data Information Set (HEDIS) Chlamydia Screening (CHL) Members assigned female at birth ages 16 [...]Read more
Reminder- Collecting Social Determinants of Health (SDOH) Data
October 17, 2024 / by Health Plan / Alerts
Date: October 16, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Primary Care Physicians Type: Educational/Informational Subject: Reminder- Collecting Social Determinants of Health (SDOH) Data Business: Medi-Cal Managed Care As part of the Department of Health Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiative introduced in 2019, [...]Read more
Breast Cancer Screening (BCS-E) and Cervical Cancer Screening (CCS) – Measurement Year 2024 HEDIS
October 17, 2024 / by Health Plan / Alerts
Date: October 16, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan PCP's & OBGYN Type: Educational/Informational Subject: Breast Cancer Screening (BCS-E) and Cervical Cancer Screening (CCS) – Measurement Year 2024 HEDIS Business: Medi-Cal Managed Care Measurement Year 2024 Healthcare Effectiveness Data Information Set (HEDIS) BCS-E - Breast Cancer [...]Read more
Dignity Health Contract Renewal Agreement – Update
October 3, 2024 / by Health Plan / Alerts
Date: October 02, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers, Facilities and Hospitals Type: Informational Subject: Dignity Health Contract Renewal Agreement - Update Business: Medi-Cal Managed Care Health Plan is proud to announce that we have reached an agreement on new contracts with Dignity Health. The [...]Read more
The Department of Health Care Services (DHCS) Webinar: Enhanced Care Management (ECM) Referral Standards and Presumptive Authorization Guidance
October 3, 2024 / by Health Plan / Alerts
Date: October 02, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Enhanced Care Management Providers Type: Informational Subject: The Department of Health Care Services (DHCS) Webinar: Enhanced Care Management (ECM) Referral Standards and Presumptive Authorization Guidance Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) is [...]Read more
Implementation of Automated 835 Files
September 30, 2024 / by Health Plan / Alerts
Date: September 30, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers Type: Informational Subject: Implementation of Automated 835 Files Business: Medi-Cal Managed Care Health Plan is pleased to announce an important update to the distribution process of the 835 Electronic Remittance Advice (ERA) files. We now have [...]Read more