Health Plan of San Joaquin provider Alerts

Community Health Worker (CHW) Benefit Updates

Date: May 6, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Providers Type: Regulatory Subject: Community Health Worker (CHW) Benefit Updates Business: Medi-Cal Managed Care Effective April 1, 2025, the Department of Healthcare Services (DHCS) updated the Community Health Worker (CHW) benefit. DHCS provided additional guidance which includes [...]

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DHCS APL 24-019: Minor Consent to Outpatient Mental Health Treatment or Counseling

Date: April 29, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Practitioners and Providers Type: Regulatory Subject: DHCS APL 24-019: Minor Consent to Outpatient Mental Health Treatment or Counseling Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) issued All Plan Letter (APL) 24-019, Minor Consent [...]

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The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program – File Reconciliation Calendar Year 2024

Date: April 29, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Skilled Nursing Facilities Type: Regulatory Subject: The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program – File Reconciliation Calendar Year 2024 Business: Medi-Cal Managed Care Health Plan is providing an update on the [...]

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FDA Drug Recall Alert – Ropivacaine Hydrochloride Injection USP, 500 mg/100 mL

Date: April 28, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Practitioners, Facilities, and Hospitals Type: Informational Subject: FDA Drug Recall Alert - Ropivacaine Hydrochloride Injection USP, 500 mg/100 mL Business: Medi-Cal Managed Care On April 18, 2025, the Food and Drug Administration (FDA) released a recall announcement [...]

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2025 Income Eligibility Guidelines for the Every Woman Counts (EWC) Program

Date: April 16, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Providers, Practitioners, and Facilities Type: Informational Subject: 2025 Income Eligibility Guidelines for the Every Woman Counts (EWC) Program Business: Medi-Cal Managed Care The Health and Human Services (HHS) Federal Poverty Guidelines (FPG) are used to determine the financial eligibility [...]

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Medi-Cal Pharmacy (Rx) Update – Completion of Pediatric Integration

Date: April 16, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Practitioners, Facilities, and Hospitals Type: Informational Subject: Medi-Cal Pharmacy (Rx) Update – Completion of Pediatric Integration Business: Medi-Cal Managed Care EFFECTIVE APRIL 25, 2025, Medi-Cal Rx will complete the implementation of claim edits and prior authorization (PA) [...]

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Claims Editing System (CES)- Quarterly Update – April 2025

Date: April 09, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Providers, Practitioners, Hospitals and Facilities Type: Informational Subject: Claims Editing System (CES) - Quarterly Update - April 2025 Business: Medi-Cal Managed Care Effective April 11, 2025, Health Plan will implement a quarterly update to the Claims Editing [...]

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Reminder: DHCS Encounter Requirement – Discharge Hour

Date: April 09, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Providers and Facilities Type: Informational Subject: Reminder: DHCS Encounter Requirement – Discharge Hour Business: Medi-Cal Managed Care As part of Health Plan’s ongoing efforts to ensure accurate and compliant claims processing, we would like to remind providers [...]

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Reminder: Submit Outstanding Claims and Encounters

Date: April 09, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan PCP's, FQHC's, RHC's, Behavioral Health, SCP's Type: Informational Subject: Reminder: Submit Outstanding Claims and Encounters Business: Medi-Cal Managed Care Health Plan would like to remind that timely submission of claims and encounters increases the likelihood of timely [...]

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Department of Health Care Services (DHCS), All Plan Letter (APL) 23-029- Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans and Third-Party Entities

Date: April 09, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Department of Health Care Services (DHCS), All Plan Letter (APL) 23-029- Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans and Third-Party Entities Business: Medi-Cal Managed Care The Department of Health [...]

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