HPSJ 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 HPSJ or from another managed care plan to HPSJ. Upon request, HPSJ 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 HPSJ’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 HPSJ 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 an HPSJ member you may initiate a request for continuity of care through the provider portal, Medical Authorization Form available on the HPSJ website at www.hpsj.com, or by contacting Customer Service at (209) 942-6320 or (888) 936-7526.
If you are a non-contracted provider providing services to an HPSJ member you may initiate a request for continuity of care by submitting a Medical Authorization Form available on the HPSJ website at www.hpsj.com or by contacting Customer Service at (209) 942-6320 or (888) 936-7526.