February 7, 2024 / by Health Plan / Alerts
Date: February 07, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Pharmacy and Therapeutics Committee To: Physicians and Providers Type: Formulary Subject: Medi-Cal Benefit Updates Business: Medi-Cal Managed Care Effective March 25, 2024, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code J1726 - INJECTION, [...]
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Health Plan of San Joaquin provider Alerts
Training for New Electronic Medical Management System Coming Soon
February 12, 2024 / by Health Plan / Alerts
Date: February 12, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Network Type: Informational/Event Subject: Training for New Electronic Medical Management System Coming Soon Business: Medi-Cal Managed Care Health Plan is proud to announce that our DRE provider portal will be updated to include a new electronic medical [...]Read more
Medi-Cal Benefit Updates
February 7, 2024 / by Health Plan / Alerts
Date: February 07, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Pharmacy and Therapeutics Committee To: Physicians and Providers Type: Formulary Subject: Medi-Cal Benefit Updates Business: Medi-Cal Managed Care Effective March 25, 2024, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code J1726 - INJECTION, [...]Read more
NAMI San Joaquin County Provider Education Program
February 5, 2024 / by Health Plan / Alerts
Date: February 05, 2024 To: Health Plan Provider Network Type: Informal/Event Subject: NAMI San Joaquin County Provider Education Program Business: Medi-Cal Managed Care The National Alliance on Mental Illness (NAMI) San Joaquin County is hosting a Provider Education Program that begins on February 5, 2024. This five-session course offers a comprehensive view of the experiences [...]Read more
Retrospective Review Process
January 24, 2024 / by Health Plan / Alerts
Date: January 10, 2024 To: Health Plan Practitioners and Facilities Type: Regulatory Subject: Retrospective Review Process Business: Medi-Cal Managed Care Effective January 1, 2024, DHCS requires all Managed Care Plans to have a retrospective review process that allows providers to submit requests for care provided without prior authorization. Health Plan has established the protocol below [...]Read more
HEDIS Preseason Reminder for Measurement Year 2023 – Reporting Year 2024
December 29, 2023 / by Health Plan / Alerts
Date: December 29, 2023 To: Contracted Providers and Facilities Type: Regulatory Subject: HEDIS Preseason Reminder for Measurement Year 2023 – Reporting Year 2024 Business: Medi-Cal Managed Care REMINDER Healthcare Effectiveness Data and Information Set (HEDIS) Medical Record Review (MRR) season is coming. Lists will be faxed out in early February 2024. IMPORTANT: Please note, Health [...]Read more
Continuity of Care (CoC)
December 29, 2023 / by Health Plan / Alerts
Date: December 29, 2023 To: Health Plan Network and Non-Contracted Providers Type: Regulatory Subject: Continuity of Care (CoC) Business: Medi-Cal Managed Care In accordance with All Plan Letter (APL) 23-018 Medi-Cal Managed Care Plan Transition Policy Guide, HPSJ and Medi-Cal Managed Care Plans (MCP) will be required to engage in specific continuity of care and [...]Read more
Update – Electronic Visit Verification (EVV)
December 28, 2023 / by Health Plan / Alerts
Date: December 28, 2023 To: Health Plan Personal Care Services (PCS) and Home Health Care Services (HHCS) Providers Type: Regulatory Subject: Update – Electronic Visit Verification (EVV) Business: Medi-Cal Managed Care This alert is to inform you of the following Electronic Visit Verification (EVV) changes effective January 1, 2024. What is EVV? EVV is a [...]Read more
Healthcare Effectiveness Data Information Set (HEDIS) Regarding Chlamydia Screening in Women (CHL) Reminder
December 15, 2023 / by Health Plan / Alerts
Date: December 15, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Primary Care Providers & OB/GYN Offices Type: Informational Subject: Healthcare Effectiveness Data Information Set (HEDIS) Regarding Chlamydia Screening in Women (CHL) Reminder Business: Medi-Cal Managed Care Healthcare Effectiveness Data Information Set (HEDIS) for Measurement Year 2023 The following is reminder regarding Chlamydia Screening [...]Read more
Mandatory Signatories to the California Health and Human Services Agency Data Exchange Framework
December 14, 2023 / by Health Plan / Alerts
Date: December 14, 2023 To: Health Plan of San Joaquin (HPSJ) All Network Providers Type: Regulatory Subject: Mandatory Signatories to the California Health and Human Services Agency Data Exchange Framework Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) issued All Plan Letter (APL) 23-013 regarding Mandatory Signatories to the California Health and [...]Read more
Long Term Care (LTC) Carve-In Intermediate Care Facility (ICF) and Subacute Care Facilities
December 6, 2023 / by Health Plan / Alerts
Date: December 06, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCP), Specialists, Hospitals and Facilities Type: Informational Subject: Long Term Care (LTC) Carve-In Intermediate Care Facility (ICF) and Subacute Care Facilities Business: Medi-Cal Managed Care In accordance with All Plan Letter (APL) 23-023 and 23-027, effective January 1, 2024, all Medi-Cal [...]Read more