July 13, 2023 / by HPSJ / Alerts
Date: July 12, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers From: HPSJ Pharmacy and Therapeutics Committee Type: Informational Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective September 18, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code Q5121 - INJECTION, INFLIXIMAB-AXXQ, BIOSIMILAR, [...]
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Health Plan of San Joaquin provider Alerts
DHCS Equity and Practice Transformation Payments Program
August 2, 2023 / by HPSJ / Alerts
Date: August 2, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Provider Organizations From: HPSJ Type: Informational Subject: DHCS Equity and Practice Transformation Payments Program Business: Medi-Cal Managed Care On July 19, 2023 HPSJ hosted a virtual Look and Learn focused on the Department of Health Care Services (DHCS) Equity and Practice Transformation [...]Read more
Missing Claims Files
July 27, 2023 / by HPSJ / Alerts
Date: July 26, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Providers & Facilities From: HPSJ Type: Informational Subject: Missing Claims Files Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) has identified an issue with 837 claim files submitted between June 1, 2023, and July 21, 2023. Please be assured that our [...]Read more
Long Term Care Web Page on HPSJ Public Site
July 26, 2023 / by HPSJ / Alerts
Date: July 26, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Providers and Facilities From: HPSJ Type: Informational Subject: Long Term Care Web Page on HPSJ Public Site Business: Medi-Cal Managed Care This Provider Alert serves as a notification that Health Plan of San Joaquin (HPSJ) has created a dedicated Long-Term Care (LTC) web [...]Read more
REVISED Provider Alert – New Measure – Topical Fluoride Varnish for Children (TFL-CH) and HPSJ’s Topical Fluoride Varnish & Supplementation Benefit Reminder
July 26, 2023 / by HPSJ / Alerts
Date: July 26, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Primary Care Providers (PCP) From: HPSJ Type: Informational Subject: REVISED Provider Alert - New Measure - Topical Fluoride Varnish for Children (TFL-CH) and HPSJ’s Topical Fluoride Varnish & Supplementation Benefit Reminder Business: Medi-Cal Managed Care The following is a revision to information posted [...]Read more
Reminder – Collecting Social Determinants of Health (SDOH) Data
July 26, 2023 / by HPSJ / Alerts
Date: July 26, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Primary Care Physicians From: HPSJ Type: Informational/Educational Subject: Reminder - Collecting Social Determinants of Health (SDOH) Data Business: Medi-Cal Managed Care As part of the Department of Health Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) program introduced in 2019, Population Health Management [...]Read more
Doula Services
July 21, 2023 / by HPSJ / Alerts
Date: July 21, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCP), Specialists, Hospitals and Facilities From: HPSJ Type: Regulatory/Informational Subject: Doula Services Business: Medi-Cal Managed Care In accordance with All Plan Letter (APL) 22-031, Doula Services are a covered benefit effective January 1, 2023. The following provider alert provides information regarding [...]Read more
Skilled Nursing Facilities – Long Term Care Carve – In APL 23-004 Changes
July 21, 2023 / by HPSJ / Alerts
Date: July 21, 2023 To: Health Plan of San Joaquin (HPSJ) Contract Providers and Facilities From: HPSJ Type: Regulatory/Informational Subject: Skilled Nursing Facilities - Long Term Care Carve - In APL 23-004 Changes Business: Medi-Cal Managed Care Effective January 1, 2023, Health Plan of San Joaquin (HPSJ) is responsible for the Long-Term Care (LTC) benefit. [...]Read more
Medical Benefit Updates
July 13, 2023 / by HPSJ / Alerts
Date: July 12, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers From: HPSJ Pharmacy and Therapeutics Committee Type: Informational Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective September 18, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code Q5121 - INJECTION, INFLIXIMAB-AXXQ, BIOSIMILAR, [...]Read more
Look and Learn: DHCS Equity and Practice Transformation Payments Program
July 5, 2023 / by HPSJ / Alerts
Date: July 5, 2023 To: HPSJ Primary Care Practitioners (including OB/GYN) From: HPSJ Type: Event Subject: Look and Learn: DHCS Equity and Practice Transformation Payments Program Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) is excited to share a new Medi-Cal program that can transform your practice to better serve your Medi-Cal patients. [...]Read more
Medi-Cal Pharmacy (Rx) Update – Reinstatement of Prior Authorizations for Phase III and IV
June 28, 2023 / by HPSJ / Alerts
Date: April 26, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners and Facilities From: HPSJ Type: Informational/Educational Subject: Medi-Cal Pharmacy (Rx) Update – Reinstatement of Prior Authorizations for Phase III and IV Business: Medi-Cal Managed Care Outpatient pharmacy benefits were transitioned to Medi-Cal Rx on 1-1-2022. Due to the benefit transitioning, some medications are [...]Read more