December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Newborn Gateway- Reminder on How to Inform Families Business: Medi-Cal Managed Care As recently communicated by Health Plan, effective July 1, 2024, Assembly Bill 118, Chapter 42, Statutes of 2023, requires [...]
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Health Plan of San Joaquin provider Alerts
Medi-Cal Pharmacy (Rx) Update – Pediatric Integration
December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Practitioners and Facilities Type: Informational/Educational Subject: 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 for members 21 years of [...]Read more
Newborn Gateway- Reminder on How to Inform Families
December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Newborn Gateway- Reminder on How to Inform Families Business: Medi-Cal Managed Care As recently communicated by Health Plan, effective July 1, 2024, Assembly Bill 118, Chapter 42, Statutes of 2023, requires [...]Read more
HEDIS Preseason Reminder for Measurement Year 2024 – Reporting Year 2025
November 27, 2024 / by Health Plan / Alerts
Date: November 27, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Facilities Type: Informational/Educational Subject: HEDIS Preseason Reminder for Measurement Year 2024 – Reporting Year 2025 Business: Medi-Cal Managed Care Healthcare Effectiveness Data and Information Set (HEDIS) Medical Record Review (MRR) season is approaching. Medical Record [...]Read more
Provider Satisfaction Survey is Here
November 11, 2024 / by Health Plan / Alerts
Date: November 6, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Contracted Provider Network Type: Regulatory Subject: Provider Satisfaction Survey is Here Business: Medi-Cal Managed Care Health Plan conducts an annual Provider Satisfaction Survey for its contracted providers to capture their rate of satisfaction with Health Plan. Information [...]Read more
After Hours Survey is Here
November 11, 2024 / by Health Plan / Alerts
Date: November 6, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Claims Editing System (CES)- Quarterly Update Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) require that providers have 24 hours, [...]Read more
Claims Editing System (CES)- Quarterly Update
November 11, 2024 / by Health Plan / Alerts
Date: November 6, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Claims Editing System (CES)- Quarterly Update Business: Medi-Cal Managed Care Effective November 22, 2024. Health Plan will implement a quarterly update to the Claims Editing System (CES) to align with the [...]Read more
Cultural and Linguistic Service Updates
November 11, 2024 / by Health Plan / Alerts
Date: November 6, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers, Specialists, Hospitals and Facilities Type: Regulatory Subject: Cultural and Linguistic Service Updates Business: Medi-Cal Managed Care The Cultural and Linguistic Services department of Health Plan would like to ensure you have qualified interpreter services for members [...]Read more
Lead Screening in Children (LSC)
November 11, 2024 / by Health Plan / Alerts
Date: November 6, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Pediatrics and Primary Care Providers Type: Educational/Informational Subject: Lead Screening in Children (LSC) Business: Medi-Cal Managed Care Healthcare Effectiveness Data and Information Set (HEDIS) Lead Screening in Children (LSC) The Department of Health Services APL 20-016: Blood [...]Read more
Changes to PCP Capitation Rates- Effective December 1, 2024
November 1, 2024 / by Health Plan / Alerts
Date: November 1, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: All Health Plan Providers Type: Regulatory Subject: Changes to PCP Capitation Rates - Effective December 1, 2024 Business: Medi-Cal Managed Care Health Plan is introducing new Primary Care Provider (PCP) capitation payment rates effective December 1, 2024. Below is [...]Read more
Retrospective Review Update
October 30, 2024 / by Health Plan / Alerts
Date: October 30, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers, Practitioners, and Facilities Type: Procedural Update Subject: Retrospective Review Update Business: Medi-Cal Managed Care Health Plan has made some adjustments to the Retrospective Review Protocol to ensure our members receive care without delay. The protocol listed [...]Read more