May 4, 2023 / by Health Plan / Alerts
Date: May 4, 2023 To: Health Plan of San Joaquin (HPSJ) Long-Term-Care Facilities From: HPSJ Type: Regulatory/Informational Subject: Supplemental Payment Business: Medi-Cal Managed Care For 2023, Health Plan of San Joaquin (HPSJ) will continue paying a supplemental payment for the first 45 days of admission. Starting July 5, 2023, to receive this supplemental payment, facilities [...]
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Health Plan of San Joaquin provider Alerts
Vendor Update
May 22, 2023 / by Health Plan / Alerts
Date: May 22, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners From: HPSJ Type: Informational Subject: Vendor Update Business: Medi-Cal Managed Care Effective May 1, 2023, HPSJ is no longer offering Diabetes Prevention Program through Melon Health. We apologize to our members who may be impacted by this change. HPSJ is working to find [...]Read more
Supplemental Payment
May 4, 2023 / by Health Plan / Alerts
Date: May 4, 2023 To: Health Plan of San Joaquin (HPSJ) Long-Term-Care Facilities From: HPSJ Type: Regulatory/Informational Subject: Supplemental Payment Business: Medi-Cal Managed Care For 2023, Health Plan of San Joaquin (HPSJ) will continue paying a supplemental payment for the first 45 days of admission. Starting July 5, 2023, to receive this supplemental payment, facilities [...]Read more
Skilled Nursing Facility/Long Term Care Payment Issue
May 4, 2023 / by Health Plan / Alerts
Date: May 4, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Skilled Nursing Facility/Long Term Care From: HPSJ Type: Regulatory/Informational Subject: Skilled Nursing Facility/Long Term Care Payment Issue Business: Medi-Cal Managed Care We regret to inform you that due to a technical issue that occurred on March 31, 2023, some long-term care claims may [...]Read more
UPDATE- Monthly Capitation (CAP) Payment Scheduled for May 2023
May 4, 2023 / by Health Plan / Alerts
Date: May 4, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCP) From: HPSJ Type: Informational/Educational Subject: UPDATE- Monthly Capitation (CAP) Payment Scheduled for May 2023 Business: Medi-Cal Managed Care This notice is to inform you that your May 2023 capitation payment will be delayed. We want you to be aware of [...]Read more
Long Term Care Authorizations Update
March 22, 2023 / by Health Plan / Alerts
Date: March 21, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Skilled Nursing Facility/Long Term Care From: HPSJ Type: Procedural Update Subject: Long Term Care Authorizations Update Business: Medi-Cal Managed Care Effective January 1, 2023, Health Plan of San Joaquin (HPSJ) must authorize and cover medically necessary services provided for members residing in Skilled [...]Read more
County Resources for Winter Weather Conditions
January 10, 2023 / by Health Plan / Alerts
Date: January 10, 2023 To: HPSJ Contracted Providers and Facilities From: Health Plan of San Joaquin (HPSJ) Type: Informational Subject: County Resources for Winter Weather Conditions Business: Medi-Cal Managed Care California is bracing for a series of storms that are predicted to result in severe weather, with potentially damaging winds, heavy rain, and flooding. The [...]Read more
Upcoming HHS-OIG Survey to Primary Care Clinicians
January 10, 2023 / by Health Plan / Alerts
Date: January 10, 2023 To: HPSJ Primary Care Providers From: Health Plan of San Joaquin (HPSJ) Type: Informational Subject: Upcoming HHS-OIG Survey to Primary Care Clinicians Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) has informed HPSJ of a Medi-Cal survey on a rolling basis beginning January 9, 2023. The Office of [...]Read more
Skilled Nursing Facilities: Long Term Care Carve-In FAQs
December 23, 2022 / by Health Plan / Alerts
Date: December 23, 2022 To: HPSJ Contracted Providers and Facilities From: Health Plan of San Joaquin (HPSJ) Type: Regulatory/Informational Subject: Skilled Nursing Facilities: Long Term Care Carve-In FAQs Business: Medi-Cal Managed Care Effective January 1, 2023, Health Plan of San Joaquin (HPSJ) is responsible for the Long Term Care (LTC) benefit. HPSJ will authorize and [...]Read more
Long Term Care Skilled Nursing Facility Authorizations FAQ (coincides with provider alert posted 12/23/22)
December 23, 2022 / by Health Plan / Alerts
Long Term Care benefits for HPSJ Members (effective 1/1/23) Skilled Nursing Facility Authorizations FAQ Will Skilled Nursing Facilities (SNF) need a new authorization for LTC members residing in their facilities if there is already an approved Treatment Authorization Request (TAR) on file from Department of Health Care Services?Yes, all patients in a SNF who transition [...]Read more
Reminder – Prior Authorization/Treatment Authorization Fields
December 9, 2022 / by Health Plan / Alerts
Date: December 9, 2022 To: HPSJ Contracted Providers and Facilities From: Health Plan of San Joaquin (HPSJ) Type: Regulatory/Informational Subject: Reminder – Prior Authorization/Treatment Authorization Fields Business: Medi-Cal Managed Care The Health Plan of San Joaquin (HPSJ) Claims Provider Disputes Resolution team has identified an increase of requests related to Appeals of Medical Necessity/Utilization Management [...]Read more