Continuity of Care Information for Providers

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.

Posted on September 14th, 2022 and last modified on October 4th, 2022.

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