Claims Corner Spotlights – March 2021
COVID-19 Resources for Providers – hpsj.com/covid-19-provider-information/
Virtual Briefing on Vaccinations (2/17/21)
HPSJ Claims Director Terry Cumpian joined San Joaquin and Stanislaus County Health Officers, and host HPSJ Chief Medical Officer Dr. Lakshmi Dhanvanthari, for this event.
SEE the recorded event video.
DOWNLOAD the slides from county health officers
Dr. Maggie Park and Dr. Julie Vaishampayan.
TAKE the short Provider Survey, at hpsj.com/covid-19-vaccinations-webinar/.
Coming Soon: Enhanced Provider Dispute Resolution (PDR) Process
As part of Health Plan of San Joaquin’s (HPSJ) continued efforts to ensure each Provider Dispute Resolution (PDR) is appropriately routed for review, HPSJ will soon introduce a streamlined PDR process. Look for details in a Provider Alert, coming in the next few weeks
National Drug Code (NDC) Required
If claims are submitted without the required NDC, or with an invalid NDC, the claim will deny. Resubmission of a Corrected Claim will be required. See Corrected Claims Provider Alerts, at www.hpsj.com/alerts/. There you will find the latest related Provider Alert, from November 5, 2020, **Reminder** DHCS Encounter Requirement – NDC Required (Update).
DHCS Encounter Requirements – Claim submissions.
As part of HPSJ’s continued efforts to ensure each claim submission will reconcile with each encounter submission to DHCS, HPSJ has implemented several new claim denials if claims are not submitted with the required information. If a denial is received, a resubmission of the claim with the corrected/additional information is required using the Corrected Claim Process.
If Authorization is Required
If authorization is required for services, the authorization number is required to be billed on the claim. If no authorization is required, please leave the field blank to avoid unnecessary denials. CMS1500 = box 23 (Prior Authorization Number). UB04 = box 63 (Treatment Authorization Codes).
Coming Soon: Enhanced Provider Dispute Resolution (PDR) Process
We think you will be pleased with the new payment system coming this July. Our improved
Payment Portal will be available to ALL HPSJ Providers, with these advantages –
- Online storage for 10 years of all your Remittance Advice and Capitation documents – view online or download in PDF or Excel format, your choice!
- Search using common fields like a check number, member-ID, date, etc.
- More choices for how you want to receive payment.
- Streamlined process to receive electronic payment directly to your bank account – if that is what you prefer.
- Support whenever you want it, 24/7!
Look for more information, plus staff training opportunities, as we approach the July switch-over.
Provider Manual
Find the updated Provider Manual through our internet portal, Doctor’s Referral Express (DRE), or www.hpsj.com. [Provider Alert, February 11, 2021]