Provider Alerts

Health Plan is proud to announce that our current claims processing system will be upgraded to QNXT 2.0, which will go-live on July 25, 2025. This upgrade is aimed at streamlining claims processing and enhancing overall operational efficiency.

Key benefits include:

• Quicker turnaround times in adjudicating claims
• Increase in timely provider payments
• Improved accuracy for processing at first claim submission
• Reduced volume of claims requiring manual pricing
• Updates to benefits to align with Medi-Cal guidelines
• Revamped authorization requirements

Next Steps:

As part of the QNXT 2.0 upgrade, Health Plan will pause adjudication of new claims from July 7 through July 24, 2025. Claims received on or before July 6, 2025, will continue to be processed during this time. During this time, you do not need to stop your claims submission to Health Plan and can continue to submit as normal.

Health Plan is actively working to process all claims, including backlog items, to ensure that any claims received before the system cutover are completed prior to the QNXT 2.0 go-live weekend (scheduled for July 25, 2025). As the claims inventory is closed out, you may notice variations in payment amounts. All claims will continue to be processed within forty-five (45) working days from the date of complete submission. The first check run after go-live is scheduled for July 29, 2025.

If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org