August 5, 2019 / by Health Plan / Alerts
Date: August 5, 2019 To: Health Plan of San Joaquin (HPSJ) Network: PCP, OB/GYN, Behavioral Health From: HPSJ Provider Services Department Subject: HEDIS Training BREAKFAST & LEARN – Practical Tips for Your Success This Year Our HPSJ providers are essential partners in delivering care to our members. Because of your valued contributions, we are glad […]
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Health Plan of San Joaquin provider Alerts
Paper Claims Submission – Address Change
September 6, 2019 / by Health Plan / Alerts
Date: September 5, 2019 To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities From: HPSJ Claims Department Subject: Paper Claims Submission – Address Change Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) will have a new mailing address for initial and corrected paper claim(s) submissions. Effective October 1, 2019 all paper […]
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**Reminder** Provider Dispute Resolution (PDR) Submission
September 5, 2019 / by Health Plan / Alerts
Date: September 4, 2019 To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities From: HPSJ Claims Department Subject: **Reminder** Provider Dispute Resolution (PDR) Submission Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) would like to remind providers and facilities of proper protocol for submitting Provider Dispute Resolutions (PDRs). Contracted Providers must […]
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HEDIS Training Breakfast & Learn
August 5, 2019 / by Health Plan / Alerts
Date: August 5, 2019 To: Health Plan of San Joaquin (HPSJ) Network: PCP, OB/GYN, Behavioral Health From: HPSJ Provider Services Department Subject: HEDIS Training BREAKFAST & LEARN – Practical Tips for Your Success This Year Our HPSJ providers are essential partners in delivering care to our members. Because of your valued contributions, we are glad […]
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DHCS Encounter Requirement – NDC Required
August 5, 2019 / by Health Plan / Alerts
Date: August 5, 2019 To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities From: HPSJ Claims Department Subject: DHCS Encounter Requirement – NDC Required Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) was recently informed the California Department of Health Care Services (DHCS) is requiring the National Drug Code (NDC) […]
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CMS-Required Fraud, Waste, and Abuse (FWA) Training for HPSJ Providers
July 24, 2019 / by Health Plan / Alerts
Date: July 24, 2019 To: Health Plan of San Joaquin (HPSJ) Providers From: HPSJ Provider Networks Department Subject: CMS-Required Fraud, Waste, and Abuse (FWA) Training for HPSJ Providers Business: Medi-Cal Health Plan of San Joaquin, as a licensed health care services plan regulated by the Department of Managed Health Care (DMHC) and contracted with the […]
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Pediatric Palliative Care
July 11, 2019 / by Health Plan / Alerts
Date: July 11, 2019 To: Health Plan of San Joaquin (HPSJ) Providers From: HPSJ Medical Management Department Subject: Pediatric Palliative Care Business: Medi-Cal Medi-Cal plans are required to provide palliative care services to their pediatric members (APL 18-020). A member under 21 years of age can receive palliative care and hospice services concurrently with curative […]
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Important Information: HEDIS Tip Sheet, G0447
July 11, 2019 / by Health Plan / Alerts
Date: July 11, 2019 To: All Health Plan of San Joaquin (HPSJ) Contracted Providers, Facilities, and Ancillary Services From: HPSJ Quality Management Department Subject: Important Information: HEDIS Tip Sheet, G0447 Business: Medi-Cal The annual HEDIS Provider Tip Sheet is a tool used to inform providers of the value set codes published at the national level […]
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Revised DHCS FSR/MRR tool
June 28, 2019 / by Health Plan / Alerts
Date: June 28, 2019 To: Health Plan of San Joaquin (HPSJ) PCP sites and Facilities From: HPSJ Quality Management Department Subject: Revised DHCS FSR/MRR tool Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) is charged with maintaining the quality of care for our members. Therefore, each of HPSJ’s contracted PCP sites is subject […]
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UPDATE – Recovery Payments – Non-Invasive Vascular Diagnostic Studies
June 14, 2019 / by Health Plan / Alerts
Date: June 13, 2019 To: Health Plan of San Joaquin (HPSJ) Practitioners and Providers and Dialysis Clinics From: HPSJ Claims Departmen Subject: UPDATE – Recovery Payments – Non-Invasive Vascular Diagnostic Studies Business: Medi-Cal HPSJ recently identified a system issue which may have caused erroneous payments on specific codes for Non-Invasive Vascular Diagnostic Studies (NVDS). We […]
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Formulary Update effective 8/19/2019
June 13, 2019 / by Health Plan / Alerts, Pharmacy Announcements
Date: June 12, 2019 To: Health Plan of San Joaquin (HPSJ) Practitioners, Providers and Facilities From: Health Plan of San Joaquin Pharmacy and Therapeutics Committee Subject: Formulary Update effective 8/19/2019 Business: Medi-Cal Effective 8/19/2019, the Pharmacy and Therapeutics Committee has approved the following changes: Additions to the Formulary: Semaglutide (Ozempic) Pen Injector: PA required. […]
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