July 12, 2022 / by Health Plan / Alerts
Date: July 11, 2022 To: HPSJ Practitioners, Providers and Facilities From: Health Plan of San Joaquin (HPSJ) Subject: Virtual Look and Learn Business: Medi-Cal Managed Care Please join us July 20, 2022, from 12:00 pm to 1:00 pm, for a Virtual Provider Look and Learn Session. We will be covering the following items: WIC Services [...]
Read more
Health Plan of San Joaquin provider Alerts
Provider Panel Capacity (Open/Closed Status)
August 8, 2022 / by Health Plan / Alerts
Date: August 05, 2022 To: HPSJ PCPs, Providers and Family Practitioners From: Health Plan of San Joaquin (HPSJ) Subject: Provider Panel Capacity (Open/Closed Status) Business: Medi-Cal Managed Care Appointment Access and Availability for Health Plan of San Joaquin (HPSJ) members is crucial to their health care. All HPSJ providers are considered “open” to serve new [...]Read more
Medical Benefit Updates
August 1, 2022 / by Health Plan / Alerts
Date: July 29, 2022 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers From: Health Plan of San Joaquin Pharmacy and Therapeutics Committee Subject: Medical Benefit Updates Business: Medi-Cal Managed Care Effective October 4, 2022, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. All of the below criteria [...]Read more
Virtual Look and Learn August 3, 2022
July 18, 2022 / by Health Plan / Alerts
Date: July 18, 2022 To: HPSJ Primary Care Physicians (PCP), Hospitals, and Facilities From: Health Plan of San Joaquin (HPSJ) Subject: Virtual Look and Learn August 3, 2022 Business: Medi-Cal Managed Care Please join us August 3, 2022 from 12:00 pm to 1:00 pm, for a Virtual Provider Look and Learn Session. We will be [...]Read more
HEDIS Measure Colorectal Cancer Screening-(COL)
July 18, 2022 / by Health Plan / Alerts
Date: July 15, 2022 To: CONTRACTED PCPs & Facilities From: Health Plan of San Joaquin (HPSJ) Subject: HEDIS Measure Colorectal Cancer Screening-(COL) Business: Medi-Cal HEDIS: New Reporting for 2022 Description: Members 50-75 years of age as of December 31 of the measurement year who had appropriate screening for cancer. ADDED: New Data Elements Table for [...]Read more
Childhood Lead Screening (LSC)- 2022 HEDIS Measure
July 18, 2022 / by Health Plan / Alerts
Date: July 15, 2022 To: HPSJ Contracted PCPs & Pediatrics From: Health Plan of San Joaquin (HPSJ) Subject: Childhood Lead Screening (LSC)- 2022 HEDIS Measure Business: Medi-Cal HEDIS Measure-(LSC) Just Check the Box! Description: Children covered by Medi-Cal are required by the Federal Centers for Medicare and Medicaid Services (CMS) to receive lead screening tests [...]Read more
Follow-up After Emergency Department Visit for Substance Use (FUA)
July 14, 2022 / by Health Plan / Alerts
Date: July 14, 2022 To: CONTRACTED PCPs and Behavioral Health Care Providers From: Health Plan of San Joaquin (HPSJ) Subject: Follow-up After Emergency Department Visit for Substance Use (FUA) Business: Medi-Cal HEDIS Measure Change 2022 Follow- up After Emergency Department Visit for Substance Use: Revised measure name from Follow-up After Emergency Department for Alcohol and [...]Read more
Follow-up After Emergency Department Visit for Substance Use (FUA)
July 14, 2022 / by Health Plan / Alerts
Date: July 14, 2022 To: CONTRACTED PCPs and Behavioral Health Care Providers From: Health Plan of San Joaquin (HPSJ) Subject: Follow-up After Emergency Department Visit for Substance Use (FUA) Business: Medi-Cal HEDIS Measure Change 2022 Follow- up After Emergency Department Visit for Substance Use: Revised measure name from Follow-up After Emergency Department for Alcohol and [...]Read more
Modifier 22 Documentation Requirements
July 14, 2022 / by Health Plan / Alerts
Date: July 12, 2022 To: HPSJ Providers & Facilities From: Health Plan of San Joaquin (HPSJ) Subject: Modifier 22 Documentation Requirements Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) guidelines state that when billing modifier 22, which indicates that a procedure was complicated, complex, difficult, or took significantly more time than usually [...]Read more
Virtual Look and Learn
July 12, 2022 / by Health Plan / Alerts
Date: July 11, 2022 To: HPSJ Practitioners, Providers and Facilities From: Health Plan of San Joaquin (HPSJ) Subject: Virtual Look and Learn Business: Medi-Cal Managed Care Please join us July 20, 2022, from 12:00 pm to 1:00 pm, for a Virtual Provider Look and Learn Session. We will be covering the following items: WIC Services [...]Read more
REMINDER- Authorization Required on Claims
July 6, 2022 / by Health Plan / Alerts
Date: July 5, 2022 To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities From: HPSJ Subject: REMINDER- Authorization Required on Claims Business: Medi-Cal Managed Care An internal claims audit revealed that the prior authorization number (entered on a CMS 1500 claim form) and the treatment authorization number (entered on a UB04 claim form) [...]Read more