Health Plan of San Joaquin provider Alerts

New Prior Authorization Form

December 1, 2014 PROVIDER ALERT To: Health Plan of San Joaquin (HPSJ) Physicians, Providers, and Pharmacies From: Health Plan of San Joaquin Pharmacy Department Subject: New Prior Authorization Form Required effective 1/1/2015 Products: All Senate Bill (SB) 866 will become effective for DMHC regulated Health Plans (including HPSJ) on January 1st, 2015. This law requires […]

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Recommendations For Synagis 2014-2015

RECOMMENDATIONS FOR SYNAGIS 2014-2015 CPT Code 96372 The American Academy of Pediatrics (AAP) recommends the use of palivizumab (Synagis), an RSV monoclonal antibody vaccine, to prevent serious RSV illness in qualifying high-risk infants. The 2014 AAP recommendations (Red Book 29th edition) as well as the 2014 CCS Synagis Guidelines (NL: 13-0914) are incorporated into the […]

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Annual Access Study

November 21, 2014 PROVIDER ALERT To: Primary Care Providers (PCP) and Specialists From: Quality Management Department Subject: Annual Access Study Products: Medi-Cal The California Department of Managed Health Care requires health plans to establish metrics for measuring and monitoring the adequacy of a health plan’s contracted provider network to provide enrollees with timely access to […]

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ACA Section 1202 Payment – 10/29/2014

October 21, 2014 ACA Section 1202 Payment Provider Alert To: HPSJ Providers (Excluding Federally Qualified Health Clinics (FQHC) and Rural Health Clinics (RHCs) From: Provider Relations Department Pursuant to the Affordable Care Act (ACA) as amended by the H.R. 4872-24 Health Care and Education Reconciliation Act of 2010, Section 1202, ACA and 42 Code of […]

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PCP Assignments for Duals – 10/24/2014

PCP Assignments for HPSJ Members with Dual Coverage To: Health Plan of San Joaquin Providers From: Provider Services Department Product: Medicare/Medi-Cal Program Effective October 1, 2014, HPSJ members’ covered by Medicare Part B or Medicare Part A & B will not have an HPSJ primary care provider designated. ID cards issued after October 15th will […]

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Formulary Update HPSJ -10/21/2014

To: Health Plan of San Joaquin (HPSJ) Physicians and Providers From: Health Plan of San Joaquin Pharmacy and Therapeutics Committee Date: September 16, 2014 Subject: Formulary status changes Products: Medi-Cal, AIM Formulary Update Effective 9/16/2014, the Pharmacy and Therapeutics Committee has approved the following changes. Formulary Status Changes: Rabeprazole (Aciphex) – Prior authorization (PA) required. […]

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Formulary Update SJHA – 10/21/2014

To: San Joaquin Health Administrators (SJHA) Physicians and Providers From: Health Plan of San Joaquin Pharmacy and Therapeutics Committee Date: September 16, 2014 Subject: Formulary status changes Products: SJHA Formulary Update Effective 9/16/2014, the Pharmacy and Therapeutics Committee has approved the following changes. Formulary Status Changes: Adalimumab (Humira), Etanercept (Enbrel), Golimumab (Simponi) – Additional indication […]

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Dental Anesthesia Services – Medi-Cal Program – 10/2/2014

September 26, 2014 Dental Anesthesia Services – Medi-Cal Program To: Health Plan of San Joaquin Dental Anesthesia Providers From: Provider Services Department Recently, Health Plan of San Joaquin discovered some irregularities in our Medi-Cal dental authorization requests for general anesthesia. We want to take this opportunity to remind you of the requirements for general anesthesia […]

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