April 12, 2024 / by Health Plan / Alerts
Date: April 10, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Physicians, Providers, and Facilities Type: Formulary Subject: Medical Benefit Update Business: Medi-Cal Managed Care Effective June 13, 2024, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code 91304 - SARSCOV2 [...]
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Health Plan of San Joaquin provider Alerts
Annual Timely Access Report – Measurement Year 2022
April 17, 2024 / by Health Plan / Alerts
Date: April 17, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers Type: Informational Subject: Annual Timely Access Report – Measurement Year 2022 Business: Medi-Cal Managed Care The Department of Managed Health Care (DMHC) published the Annual Timely Access Report results for Measurement Year (MY) 2022. The report summarizes provider appointment availability [...]Read more
Medical Benefit Update
April 12, 2024 / by Health Plan / Alerts
Date: April 10, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Physicians, Providers, and Facilities Type: Formulary Subject: Medical Benefit Update Business: Medi-Cal Managed Care Effective June 13, 2024, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code 91304 - SARSCOV2 [...]Read more
Post Stabilization Information for Hospitals
April 11, 2024 / by Health Plan / Alerts
Date: April 10, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers, Facilities, and Hospitals Type: Regulatory Subject: Post Stabilization Information for Hospitals Business: Medi-Cal Managed Care California Health and Safety Code1262.8, includes various provisions regarding emergency and post-stabilization care. Post-stabilization care is defined as medically necessary [...]Read more
Incorrect Check Payments Issued
April 9, 2024 / by Health Plan / Alerts
Date: April 09, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers Type: Informational Subject: Incorrect Check Payments Issued Business: Medi-Cal Managed Care This alert is to notify you that fee-for-service (FFS) payment checks dated 4/2/2024 were mailed and subsequently canceled after it was identified that payments [...]Read more
Health Alert- Measles
March 27, 2024 / by Health Plan / Alerts
Date: March 27, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers, Hospitals, and Facilities Type: Regulatory Subject: Health Alert- Measles Business: Medi-Cal Managed Care The Health Plan was recently informed of a confirmed case of Measles in Stanislaus County. Please review the attached health alert which [...]Read more
Specialist Referral Form No Longer Required
March 27, 2024 / by Health Plan / Alerts
Date: March 27, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers and Facilities Type: Informational/Educational Subject: Specialist Referral Form No Longer Required Business: Medi-Cal Managed Care The Specialist Referral Form is no longer required by Health Plan. Effective immediately, the form has been removed from hpsj.com. [...]Read more
IMPORTANT: Change Healthcare Payments Notification – Update 2
March 22, 2024 / by Health Plan / Alerts
Date: March 21, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Providers Type: Informational Subject: IMPORTANT: Change Healthcare Payments Notification – Update 2 Business: Medi-Cal Managed Care The remittance advice (RA)/explanation of payment (EOP) details is now available starting today. All providers will now have the ability [...]Read more
Prospective Payment System (PPS) Implementation
March 20, 2024 / by Health Plan / 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, [...]Read more
Updates to the ECM and Community Supports Healthcare Common Procedure Coding System (HCPCS) Coding Guidance
March 11, 2024 / by Health Plan / 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) [...]Read more
Reminder: New Claims Processes
March 11, 2024 / by Health Plan / 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 [...]Read more