July 13, 2023 / by Health Plan / Alerts
Date: July 12, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers From: HPSJ Pharmacy and Therapeutics Committee Type: Informational Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective September 18, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code Q5121 - INJECTION, INFLIXIMAB-AXXQ, BIOSIMILAR, [...]
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Health Plan of San Joaquin provider Alerts
Doula Services
July 21, 2023 / by Health Plan / Alerts
Date: July 21, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCP), Specialists, Hospitals and Facilities From: HPSJ Type: Regulatory/Informational Subject: Doula Services Business: Medi-Cal Managed Care In accordance with All Plan Letter (APL) 22-031, Doula Services are a covered benefit effective January 1, 2023. The following provider alert provides information regarding [...]Read more
Skilled Nursing Facilities – Long Term Care Carve – In APL 23-004 Changes
July 21, 2023 / by Health Plan / Alerts
Date: July 21, 2023 To: Health Plan of San Joaquin (HPSJ) Contract Providers and Facilities From: HPSJ Type: Regulatory/Informational Subject: Skilled Nursing Facilities - Long Term Care Carve - In APL 23-004 Changes Business: Medi-Cal Managed Care Effective January 1, 2023, Health Plan of San Joaquin (HPSJ) is responsible for the Long-Term Care (LTC) benefit. [...]Read more
Medical Benefit Updates
July 13, 2023 / by Health Plan / Alerts
Date: July 12, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers From: HPSJ Pharmacy and Therapeutics Committee Type: Informational Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective September 18, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code Q5121 - INJECTION, INFLIXIMAB-AXXQ, BIOSIMILAR, [...]Read more
Look and Learn: DHCS Equity and Practice Transformation Payments Program
July 5, 2023 / by Health Plan / Alerts
Date: July 5, 2023 To: HPSJ Primary Care Practitioners (including OB/GYN) From: HPSJ Type: Event Subject: Look and Learn: DHCS Equity and Practice Transformation Payments Program Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) is excited to share a new Medi-Cal program that can transform your practice to better serve your Medi-Cal patients. [...]Read more
Medi-Cal Pharmacy (Rx) Update – Reinstatement of Prior Authorizations for Phase III and IV
June 28, 2023 / by Health Plan / Alerts
Date: April 26, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners and Facilities From: HPSJ Type: Informational/Educational Subject: Medi-Cal Pharmacy (Rx) Update – Reinstatement of Prior Authorizations for Phase III and IV 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 [...]Read more
Update – Value Based Payment (VBP) Program
June 28, 2023 / by Health Plan / Alerts
Date: June 28, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Providers From: HPSJ Type: Regulatory/Informational Subject: Update – Value Based Payment (VBP) Program Business: Medi-Cal Managed Care The following is to inform HPSJ Contracted Providers that there will be a delay for the June 2023 Value Based Payment (VBP) program payments. Our HPSJ [...]Read more
Lead Screening in Children (LSC)- 2023 HEDIS Measure
June 28, 2023 / by Health Plan / Alerts
Date: June 28, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Pediatrics and Primary Care Providers (PCP) From: HPSJ Type: Informational Subject: Lead Screening in Children (LSC)- 2023 HEDIS Measure Business: Medi-Cal Managed Care Healthcare Effectiveness Data and Information Set (HEDIS) Measure for 2023 Lead Screening in Children (LSC) Guidelines Update All California providers [...]Read more
Eye Injections Reference Sheet for Ophthalmologists
June 28, 2023 / by Health Plan / Alerts
Date: June 28, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners and Facilities From: HPSJ Type: Educational/Informational Subject: Eye Injections Reference Sheet for Ophthalmologists Business: Medi-Cal Managed Care The Pharmacy and Therapeutics (P&T) Committee provided medical benefit updates in a provider alert issued in April of 2023. As a result, the attached informational reference [...]Read more
Dyadic Services and Family Therapy Benefit
June 13, 2023 / by Health Plan / Alerts
Date: June 13, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers, Specialists, Hospitals and Facilities From: HPSJ Type: State Regulatory Subject: Dyadic Services and Family Therapy Benefit Business: Medi-Cal Managed Care In accordance with All Plan Letter (APL) 22-029, the Dyadic services and family therapy benefit are effective January 1, 2023. Per [...]Read more
Dual Members: Overpayments
May 30, 2023 / by Health Plan / Alerts
Date: May 30, 2023 To: Health Plan of San Joaquin (HPSJ) Long Term Care Providers From: HPSJ Type: Announcement Subject: Dual Members: Overpayments Business: Medi-Cal Managed Care Medicare/Medi-Cal (Dual) HPSJ Members & Long-Term Care Claims for Medicare/Medi-Cal recipients must first be billed to the appropriate Medicare carrier or intermediary for processing of Medicare benefits. Medi-Cal [...]Read more