October 3, 2023 / by Health Plan / Alerts
Date: October 03, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers Type: Formulary Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective December 11, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code J2327 – INJECTION, RISANKIZUMAB-RZAA, (SKYRIZI), 1 MG: For Acute and Chronic [...]
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Health Plan of San Joaquin provider Alerts
All Plan Letter 22-005 No Wrong Door for Mental Health Services Policy
October 18, 2023 / by Health Plan / Alerts
Date: October 18, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners and Facilities Type: Informational/ Educational Subject: All Plan Letter 22-005 No Wrong Door for Mental Health Services Policy Business: Medi-Cal Managed Care This is being sent as a reminder on how you can apply the information to your practice or facility operations, where […]
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Healthcare Effectiveness Data and Information Set (HEDIS) – 2023 Diabetes Care Measures
October 18, 2023 / by Health Plan / Alerts
Date: October 17, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCPs), Federally Qualified Health Centers (FQHCs), Rural Health Clinics, and Facilities Type: Regulatory Subject: Healthcare Effectiveness Data and Information Set (HEDIS) – 2023 Diabetes Care Measures Business: Medi-Cal Managed Care The following is regarding an update to Health Effectiveness Data and […]
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Medi-Cal Pharmacy (Rx) Update – Phase IV, Waves 1, 2, 3, Enteral Nutrition
October 18, 2023 / by Health Plan / Alerts
Date: October 17, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners and Facilities From: HPSJ Type: Informational/Educational Subject: Medi-Cal Pharmacy (Rx) Update – Phase IV, Waves 1, 2, 3, Enteral Nutrition Business: Medi-Cal Managed Care Outpatient pharmacy benefits were transitioned to Medi-Cal Rx on 1-1-2022. Due to the benefit transitioning, some medications are paid [...]Read more
Provider Appointment Availability Survey is Here -UPDATED
October 5, 2023 / by Health Plan / Alerts
Date: October 05, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers, Specialists, Behavioral Health Providers, Hospitals and Ancillary Providers Type: Regulatory Subject: Provider Appointment Availability Survey is Here Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) is required by the California Department of Health Care Services (DHCS) to monitor providers […]
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Community Baby Shower – Supporting Black Maternal Health Initiative
October 4, 2023 / by Health Plan / Alerts
Date: October 04, 2023 To: Health Plan of San Joaquin (HPSJ) OBGYN and Pediatric Practitioners Type: Informational/ Event Subject: Community Baby Shower – Supporting Black Maternal Health Initiative Business: Medi-Cal Managed Care Community event, please post and encourage your patients to attend! Health Plan of San Joaquin (HPSJ) is focused on working with local providers [...]Read more
Vaccines for Children (VFC) Program
October 4, 2023 / by Health Plan / Alerts
Date: October 04, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Primary Care Providers (PCP), Pediatricians, Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC), Native American Health Centers (NAHC Type: Informational/ Educational Subject: Vaccines for Children (VFC) Program Business: Medi-Cal Managed Care The following provides information regarding the Vaccines for Children (VFC) [...]Read more
Skilled Nurse Facilities (SNF) / Long Term Care (LTC) Erroneous Denials
October 4, 2023 / by Health Plan / Alerts
Date: October 04, 2023 To: Health Plan of San Joaquin (HPSJ) All Providers and Facilities Type: Regulatory/Informational Subject: Skilled Nurse Facilities (SNF)/ Long Term Care (LTC) Erroneous Denials Business: Medi-Cal Managed Care HPSJ has identified an issue where denial notices were incorrectly issued for “admission date is greater than the statement through date” for all [...]Read more
Medical Benefits Updates
October 3, 2023 / by Health Plan / Alerts
Date: October 03, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers Type: Formulary Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective December 11, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code J2327 – INJECTION, RISANKIZUMAB-RZAA, (SKYRIZI), 1 MG: For Acute and Chronic [...]Read more
Place of Service Billing for Services in FQHCs and RHCs
September 27, 2023 / by Health Plan / Alerts
Date: September 27, 2023 To: Health Plan of San Joaquin (HPSJ) Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) From: Health Plan of San Joaquin (HPSJ) Type: Regulatory Subject: Place of Service Billing for Services in FQHCs and RHCs Business: Medi-Cal Managed Care Effective December 1, 2023, claims for payment of services that [...]Read more
Look and Learn – New HEDIS Portal – Inovalon – Training
September 22, 2023 / by Health Plan / Alerts
Date: September 22, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCPs), Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) From: Health Plan of San Joaquin (HPSJ) Type: Event/Informational Subject: Look and Learn – New HEDIS Portal – Inovalon – Training Business: Medi-Cal Managed Care Health Plan of San Joaquin [...]Read more