| Date: | March 2, 2020 |
| To: | Health Plan of San Joaquin (HPSJ) All Practitioners and Facilities |
| From: | HPSJ Claims Department |
| Subject: | Cost Avoidance and Post-Pay Recoveries – Coming DHCS Intervention |
| Business: | Medi-Cal Managed Care |
State Law requires Medi-Cal and Managed Care Plans (MCP’s) to be the payer of last resort for services in which there is a responsible third-party, also known as Other Healthcare Coverage (OHC).
While Health Plan of San Joaquin’s (HPSJ) current policy reflects the requirement, new guidelines are being presented by the California Department of Healthcare Services (DHCS) to ensure both providers and MCP’s are doing their part to correctly identify OHC and avoid unnecessary costs.
A coming All Plan Letter (APL), currently in draft form, will require MCP’s to submit, on a monthly basis to DHCS, detailed information regarding uncollected recoveries. DHCS will then conduct a post-payment recovery and/or leverage its recovery contractor to initiate recoveries on their behalf.
What can you do to avoid DHCS collections?
- Ensure front-end staff validate eligibility for members at each visit through the
Medi-Cal Eligibility Portal, https://www.medi-cal.ca.gov/Eligibility/Login.asp. - Respond to any Recovery Demands sent by HPSJ within the allocated timeframe.
- Return any overpayment to HPSJ within 60 calendar days after the date on which the over payment was identified (APL 17-003) and/or immediately after OHC is identified.
We hope this preview of the coming DHCS All Plan Letter draft will be helpful for your
billing operation.
If you have questions, please contact our Customer Service Department at 209-942-6320.