December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Newborn Gateway- Reminder on How to Inform Families Business: Medi-Cal Managed Care As recently communicated by Health Plan, effective July 1, 2024, Assembly Bill 118, Chapter 42, Statutes of 2023, requires [...]
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Health Plan of San Joaquin provider Alerts
Medicare Dual Special Needs Plan (D-SNP)
December 18, 2024 / by Health Plan / Alerts
Date: December 18, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers Type: Regulatory Subject: Medicare Dual Special Needs Plan (D-SNP) Business: Medi-Cal Managed Care Starting January 1, 2026 and subject to regulatory approval, Health Plan will be offering a Medicare Dual Special Needs Plan (D-SNP). D-SNPs are [...]Read more
Update – Calendar Year (CY) 2024 Medi-Cal Targeted Rate Increases (TRI) and Changes to PCP Capitation Rates
December 16, 2024 / by Health Plan / Alerts
Date: December 12, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Primary Care Providers and Capitation Payments Type: Regulatory Subject: Update - Calendar Year (CY) 2024 Medi-Cal Targeted Rate Increases (TRI) and Changes to PCP Capitation Rates Business: Medi-Cal Managed Care Health Plan recently communicated about the Medi-Cal [...]Read more
How to refer for Behavioral Health Services and Case Management
December 16, 2024 / by Health Plan / Alerts
Date: December 11, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Practitioners and Facilities Type: Informational/Educational Subject: How to refer for Behavioral Health Services and Case Management Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) issued All Plan Letter 22-005 (APL-22-005) “No Wrong Door for [...]Read more
Medi-Cal Pharmacy (Rx) Update – Pediatric Integration
December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Practitioners and Facilities Type: Informational/Educational Subject: Medi-Cal Pharmacy (Rx) Update – Pediatric Integration Business: Medi-Cal Managed Care EFFECTIVE JANUARY 31, 2025, Medi-Cal Rx will reinstate claim edits and prior authorization (PA) requirements for members 21 years of [...]Read more
Newborn Gateway- Reminder on How to Inform Families
December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Newborn Gateway- Reminder on How to Inform Families Business: Medi-Cal Managed Care As recently communicated by Health Plan, effective July 1, 2024, Assembly Bill 118, Chapter 42, Statutes of 2023, requires [...]Read more
HEDIS Preseason Reminder for Measurement Year 2024 – Reporting Year 2025
November 27, 2024 / by Health Plan / Alerts
Date: November 27, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Facilities Type: Informational/Educational Subject: HEDIS Preseason Reminder for Measurement Year 2024 – Reporting Year 2025 Business: Medi-Cal Managed Care Healthcare Effectiveness Data and Information Set (HEDIS) Medical Record Review (MRR) season is approaching. Medical Record [...]Read more
Provider Satisfaction Survey is Here
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 Contracted Provider Network Type: Regulatory Subject: Provider Satisfaction Survey is Here Business: Medi-Cal Managed Care Health Plan conducts an annual Provider Satisfaction Survey for its contracted providers to capture their rate of satisfaction with Health Plan. Information [...]Read more
After Hours Survey is Here
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 Providers and Practitioners Type: Regulatory Subject: Claims Editing System (CES)- Quarterly Update Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) require that providers have 24 hours, [...]Read more
Claims Editing System (CES)- Quarterly Update
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 Providers and Practitioners Type: Regulatory Subject: Claims Editing System (CES)- Quarterly Update Business: Medi-Cal Managed Care Effective November 22, 2024. Health Plan will implement a quarterly update to the Claims Editing System (CES) to align with the [...]Read more
Cultural and Linguistic Service Updates
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 Providers, Specialists, Hospitals and Facilities Type: Regulatory Subject: Cultural and Linguistic Service Updates Business: Medi-Cal Managed Care The Cultural and Linguistic Services department of Health Plan would like to ensure you have qualified interpreter services for members [...]Read more