Health Plan of San Joaquin / Mountain Valley Health Plan (“Health Plan”) provides continuity of care for members when their provider is no longer part of the network or when the member is transitioning from Medi-Cal fee-for-service (FFS) to Health Plan or from another managed care plan to Health Plan. Upon request, Health Plan members can continue to see their non-contracted provider for up to 12 months when:
- Member has an existing relationship with the provider
- Provider accepts Health Plan’s reimbursement rate or Medi-Cal FFS rates
- Provider is in good standing and does not have any disqualifying quality of care issues
- Provider is a California State Plan provider
- Provider supplies Health Plan all relevant treatment information
Continuity of Care does not apply for services not covered by Medi-Cal, DME, transportation, other ancillary services, or carved-out service providers.
If you are a contracted provider providing services to a Health Plan member you may initiate a request for continuity of care through the provider portal, Medical Authorization Form available on the Health Plan’s website at www.hpsj-mvhp.org, or by contacting Customer Service at 1-209-942-6320 or 1-888-936-7526.
If you are a non-contracted provider providing services to a Health Plan member you may initiate a request for continuity of care by submitting a Medical Authorization Form available on the Health Plan website at www.hpsj-mvhp.org or by contacting Customer Service at 1-209-942-6320 or 1-888-936-7526.