Prospective Payment System (PPS) Implementation

March 20, 2024 / by HPSJ / Alerts

Date: March 20, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers, Facilities, and Hospitals Type: Regulatory Subject: Prospective Payment System (PPS) Implementation Business: Medi-Cal Managed Care Health Plan is introducing Optum’s Prospective Payment System (PPS) which has two components: EASYGroup and Rate Manager. As a result, [...]

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Updates to the ECM and Community Supports Healthcare Common Procedure Coding System (HCPCS) Coding Guidance

March 11, 2024 / by HPSJ / Alerts

Date: March 13, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Enhanced Care Management (ECM) and Community Supports Providers Type: Regulatory Subject: Updates to the ECM and Community Supports Healthcare Common Procedure Coding System (HCPCS) Coding Guidance Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) [...]

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Reminder: New Claims Processes

March 11, 2024 / by HPSJ / Alerts

Date: March 13, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan(“Health Plan”) Claims Department To: Health Plan Providers Type: Informational Subject: Reminder: New Claims Processes Business: Medi-Cal Managed Care Health Plan is implementing two new claims management processes on April 1, 2024, to support automated application of correct coding principles. Claims Pre-Payment Processing [...]

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2024 Provider Incentive Program-Quality Measures for PCP/OB-GYN

March 1, 2024 / by HPSJ / Alerts

Date: March 01, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Primary Care Providers (PCPs), Obstetrician-Gynecologist (OB-GYN Type: Informational Subject: 2024 Provider Incentive Program-Quality Measures for PCP/OB-GYN Business: Medi-Cal Managed Care Health Plan is pleased to announce the 2024 Provider Incentive Program promoting quality care for our members. [...]

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2024 Provider Incentive Program – Quality Measures for FQHC & RHC

March 1, 2024 / by HPSJ / Alerts

Date: March 01, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHC) Type: Informational Subject: 2024 Provider Incentive Program - Quality Measures for FQHC & RHC Business: Medi-Cal Managed Care Health Plan is pleased to announce the 2024 Provider [...]

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Emergency Department Practices

March 1, 2024 / by HPSJ / Alerts

Date: February 28, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Emergency Room Departments Type: Informational/Educational Subject: Emergency Department Practices Business: Medi-Cal Managed Care In accordance with the Department of Health Care Services (DHCS) regulations, Health Plan is implementing an update to enhance the care coordination for our [...]

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Mandatory Annual Trainings – Complete by 06/30/2024

March 1, 2024 / by HPSJ / Alerts

Date: February 28, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Provider Network Type: Regulatory Subject: Mandatory Annual Trainings – Complete by 06/30/2024 Business: Medi-Cal Managed Care ACTION REQUIRED Please complete ALL FOUR trainings by 06/30/2024 In accordance with California Department of Health Care Services (DHCS), Health Plan’s [...]

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Behavioral Health Look and Learn- March 13, 2024 at 10 AM

February 29, 2024 / by HPSJ / Alerts

Date: February 28, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Practitioners and Facilities Type: Event Subject: Behavioral Health Look and Learn- March 13, 2024 at 10 AM Business: Medi-Cal Managed Care Please join us March 13, 2024, from 10:00 am to 11:00 am, for a Virtual Provider [...]

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