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 [...]
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Health Plan of San Joaquin provider Alerts
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
Immunizations for Adolescents (IMA) Reminder
December 2, 2022 / by Health Plan / Alerts
Date: December 2, 2022 To: HPSJ Contracted Primary Care Providers and Pediatrics From: Health Plan of San Joaquin (HPSJ) Type: Informational/Reminder Subject: Provider Alert Website Correction regarding - Immunizations for Adolescent (IMA) Reminder Business: Medi-Cal Healthcare Effectiveness Data and Information Set (HEDIS) Measure for 2022 The following is a reminder regarding the Immunizations for Adolescents (IMA) [...]Read more
Hedis Preseason Reminder for Measurement Year 2022
December 1, 2022 / by Health Plan / Alerts
Date: December 1, 2022 To: HPSJ Contracted Providers and Facilities From: Health Plan of San Joaquin (HPSJ) Type: Informational/Educational Subject: HEDIS Preseason Reminder for Measurement Year 2022 Business: Medi-Cal Managed Care REMINDER Healthcare Effectiveness Data and Information Set (HEDIS) Medical Record Review (MRR) season is coming. Medical Record Collection for HEDIS Hybrid measures begins February [...]Read more
Medi-Cal Pharmacy (Rx) Update – Rejection Code 816
December 1, 2022 / by Health Plan / Alerts, Pharmacy Announcements
Date: December 1, 2022 To: Health Plan of San Joaquin (HPSJ) Practitioners and Facilities From: Health Plan of San Joaquin (HPSJ) Type: Informational/Educational Subject: Medi-Cal Pharmacy (Rx) Update – REJECTION CODE 816 Business: Medi-Cal Outpatient pharmacy benefits were transitioned to Medi-Cal Rx on 1-1-2022. Due to the benefit transitioning, some medications are paid for by [...]Read more