January 2, 2025 / by Health Plan / Alerts
Date: January 02, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Pharmacy and Theraputics Committee To: Health Plan Providers and Practitioners Type: Formulary Subject: Medical Benefit Update Business: Medi-Cal Managed Care Effective March 10, 2025 the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code J1632 [...]
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Health Plan of San Joaquin provider Alerts
Transgender, Gender Diverse or Intersex (TGI) Provider Directory Requirements and National Committee for Quality Assurance (NCQA) Practitioner Race and Ethnicity
January 17, 2025 / by Health Plan / Alerts
Date: January 15, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Primary Care Providers (PCPs), Specialists, Hospitals, and Facilities Type: Informational/Educational Subject: Transgender, Gender Diverse or Intersex (TGI) Provider Directory Requirements and National Committee for Quality Assurance (NCQA) Practitioner Race and Ethnicity Business: Medi-Cal Managed Care The Department [...]Read more
Non-Specialty Mental Health Outreach and Education Plan
January 17, 2025 / by Health Plan / Alerts
Date: January 15, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Primary Care Providers, Practitioners, and Facilities Type: Informational/Educational Subject: Non-Specialty Mental Health Outreach and Education Plan Business: Medi-Cal Managed Care In response to the Department of Health Care Services (DHCS) intent to increase Behavioral Health utilization across [...]Read more
2025 Provider Incentive Program
January 9, 2025 / by Health Plan / Alerts
Date: January 08, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Providers Type: Informational Subject: 2025 Provider Incentive Program Business: Medi-Cal Managed Care Health Plan is pleased to announce the 2025 Provider Incentive Program. This program rewards our providers for promoting quality care for our members. The incentive [...]Read more
REMINDER – Medi-Cal Pharmacy (Rx) Update – Pediatric Integration
January 9, 2025 / by Health Plan / Alerts
Date: January 08, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Practitioners, Facilities, and Hospitals Type: Informational / Educational Subject: REMINDER - Medi-Cal Pharmacy (Rx) Update – Pediatric Integration Business: Medi-Cal Managed Care EFFECTIVE JANUARY 31, 2025, Medi-Cal Rx will reinstate claim edits and prior authorization (PA) requirements [...]Read more
Billing Guidelines for BHT/ABA Services
January 9, 2025 / by Health Plan / Alerts
Date: January 08, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Behavioral Health Treatment (BHT) / Applied Behavioral Analysis (ABA) Providers Type: Regulatory Subject: Billing Guidelines for BHT/ABA Services Business: Medi-Cal Managed Care Through the Claims Editing System (CES), Health Plan has identified a trend in claims not [...]Read more
Provider Manual Update 45 Day Notice
January 2, 2025 / by Health Plan / Alerts
Date: January 02, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Providers and Facilities Type: Regulatory Subject: Provider Manual Update 45 Day Notice Business: Medi-Cal Managed Care The following information serves as an official 45-business day notice regarding updates to the Provider Manual. Health Plan of San Joaquin/Mountain [...]Read more
Medical Benefit Update
January 2, 2025 / by Health Plan / Alerts
Date: January 02, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Pharmacy and Theraputics Committee To: Health Plan Providers and Practitioners Type: Formulary Subject: Medical Benefit Update Business: Medi-Cal Managed Care Effective March 10, 2025 the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code J1632 [...]Read more
Calendar Year (CY) 2024 Medi-Cal Targeted Rate Increases (TRI) and Impact to Proposition 56 Directed Payments
December 30, 2024 / by Health Plan / Alerts
Date: December 30, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Behavioral Health Providers Previously Contracted with Carelon Type: Regulatory Subject: Calendar Year (CY) 2024 Medi-Cal Targeted Rate Increases (TRI) and Impact to Proposition 56 Directed Payments Business: Medi-Cal Managed Care Pursuant to the 2023 Budget Act and Assembly Bill [...]Read more
Enhanced Care Management Presumptive Authorization – Live as of 01/01/2025
December 30, 2024 / by Health Plan / Alerts
Date: December 30, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Enhanced Care Management (ECM) Providers Type: Informational Subject: Enhanced Care Management Presumptive Authorization – Live as of 01/01/2025 Business: Medi-Cal Managed Care Presumptive authorization enables the Enhanced Care Management (ECM) Provider to deliver ECM for a 30-calendar [...]Read more
Updates – DHCS APL 24-009 (Skilled Nursing Facilities), APL 24-010 (Subacute Care Facilities), APL 24-011 (Intermediate Care Facilities)
December 27, 2024 / by Health Plan / Alerts
Date: December 26, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Facilities Type: Regulatory Subject: Updates - DHCS APL 24-009 (Skilled Nursing Facilities), APL 24-010 (Subacute Care Facilities), APL 24-011 (Intermediate Care Facilities) Business: Medi-Cal Managed Care On September 16, 2024, the Department of Health Care Services (DHCS) [...]Read more