Provider Alerts

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Date: August 9, 2017

To:	Health Plan of San Joaquin (HPSJ) Practitioners and Providers
From:	HPSJ Medical Management Department
Subject:	Change – Prior Authorization Requirements for Physical Therapy and Occupational Therapy
Business:	Medi-Cal

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Effective October 11, 2017

Background
Previously, in an effort to support our providers, HPSJ removed the prior authorization requirement for an initial set of 10 physical therapy sessions and an initial set of 10 occupational therapy sessions. Any requests for additional therapy visits – either physical or occupational – would require a prior authorization. Providers received this notification in March of 2015.

Reason for Change
HPSJ has received feedback from providers on the challenges providers have been encountering with the process, As a result, HPSJ has made the decision to return to the previous prior authorization requirement for all physical and occupational therapy visits.

• • • The number of visits approved will be based on Milliman Care Guidelines.
    • These visits will be per year, starting on the date of service – NOT per calendar year.
    • Effective October 11, 2017, please submit a prior authorization request to HPSJ, using one of these two ways:
      1. Online, through the HPSJ DRE Provider Portal – enter at https://hpsj4.wpengine.com/providers/
      2. By fax, using the Prior Authorization Request form found on the HPSJ website, at https://hpsj4.wpengine.com/prior-authorizations/

With the implementation of our new Electronic Medical Management system (now scheduled to go live in late summer 2017), we are able to efficiently create and update authorization requests for this service.

We hope this change will decrease work for our providers and result in increased satisfaction for both providers and HPSJ members.

Our HPSJ network providers are important partners in delivering care to our members. Thank you!

If you have questions, please contact our Customer Services Department at (209) 942-6320.