CORRECTION – Section 12-3: UPDATE – Section 12 – HPSJ Provider Manual
| Date: | June 29, 2017 |
| To: | Health Plan of San Joaquin (HPSJ) Providers and Practitioners |
| From: | Health Plan of San Joaquin Claims & Medical Management Departments |
| Subject: | CORRECTION – Section 12-3: UPDATE – Section 12 – HPSJ Provider Manual |
| Business: | Medi-Cal, MCAP (Medi-Cal Access Program, previously known as AIM) |
Please refer to the updated Section 12 of your online HPSJ Provider Manual (hpsj4.wpengine.com), which references the Provider Dispute Resolution (PDR) process.
As always, please contact your HPSJ Customer Services Department at (209) 942-6320 for any questions, comments or concerns.
Attachments: Updated Section 12 (HPSJ Provider Manual) – 7 pages, including the following:
Section 12:
Dispute Resolution ……………………………………………………………. 12-1
Types of Disputes ………………………………………………………………………………… 12-1
Quick Reference for Filing Provider Disputes Resolution and Appeals ……… 12-1
Provider Dispute Resolution (PDR) Process …………………………………………… 12-2
Provider Appeals for Claims Payment ……………………………………………………. 12-2
Provider Appeals for Utilization Management Decisions …………………………. 12-3
Appeals for HPSJ Benefit Plan ……………………………………………………………… 12-5
All Other Provider Disputes ………………………………………………………………….. 12-5