COVID-19 Provider Updates

HPSJ: Open for Business during COVID-19 (Coronavirus) 

Health Plan of San Joaquin (HPSJ) is closely following  the advisories from the CDC, the California Department of Public Health, each of our local public health departments, and the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC).

Our message to you and each valued member of our Provider Network is –

  • We remain open for business.
  • We will be available to every part of our Provider Network throughout this time.
  • As always, you and your staff are welcome to call Customer Service with your questions, at 209.942.6320.
  • You can continue to rely on your partners at Health Plan of San Joaquin.

Should there be any changes in our business practices related to the pandemic, we will notify you as soon as possible. 

To see the practical and timely advice we are giving our members, please go to https://www.hpsj.com/coronavirus/ – including the link to CDC.

Stay Safe and thank you!

Pharmacy Updates – 

Health Plan of San Joaquin has notified our Pharmacy Network and our PBM (MC-Rx Powered by ProCare Rx) to authorize early refills for members needing extended medication supplies and 90-day supply of medications for chronic medications.

If members need to shelter-in-place, we are authorizing their medications to be filled from both in-network and out-of-network pharmacies as well as to be mailed directly to their home.

HPSJ Pharmacy staff are monitoring drug shortages and other access concerns. We will provide updates with any new developments.

We continue to provide pharmacy phone support 24/7 for our members and providers via our provider line at 1-888-936-7526, Option 1, or our PBM (MC-Rx Powered by ProCare Rx) at 1-855-828-1484.

Health Plan of San Joaquin has notified our Pharmacy Network and our PBM (MC-Rx Powered by ProCare Rx) to authorize early refills for members needing extended medication supplies and 90-day supply of medications for chronic medications.

If members need to shelter-in-place, we are authorizing their medications to be filled from both in-network and out-of-network pharmacies as well as to be mailed directly to their home.

HPSJ Pharmacy staff are monitoring drug shortages and other access concerns. We will provide updates with any new developments.

We continue to provide pharmacy phone support 24/7 for our members and providers via our provider line at 1-888-936-7526, Option 1, or our PBM (MC-Rx Powered by ProCare Rx) at 1-855-828-1484.

Mental Health Support – 

We want you to be aware that on the COVID-19 (Coronavirus) page we set up for HPSJ members, we offer this advice.

If you are feeling overwhelmed, or worried about family members:

  • Get help from HPSJ Customer Service or your county mental health plan
  • See helpful information from American Red Cross – click here
  • Call Beacon Health Strategies at 1.888.581.7526

In this time of heightened anxiety and need for support, please know that HPSJ social workers and Care Management/Disease Management teams continue to reach out to our members with support during this time of COVID-19/Coronavirus pandemic.

You and your practice may also find useful the following resources at this time, and as you continue your care for your patients.

  • Social Distancing Tips
  • Tips-social-distancing-quarantine-isolation
  • ACES Aware – COVID-19 & Stress (ACES Aware supports health care providers, their teams, and all those on the front lines of administering care and interventions as California addresses stress and anxiety related to COVID-19

https://www.acesaware.org/heal/covid19/

  • American Red Cross – Be Red Cross Ready, Coping with Shelter-in-Place Emergencies

https://www.hpsj.com/wp-content/uploads/2020/03/RedCross.ShelteringInPlace.pdf

CLAIMS UPDATES

Clarification (March 10, 2020 Alert) – Billing
  • U07.1 is for confirmed cases only and is not available to bill until 04/01/2020.
  • B97.29 should be the diagnosis code providers use for confirmed cases through 03/31/2020.
Any testing or visits, prior to confirming a COVID-19 positive case should be billed with diagnosis codes pertaining to the patient’s symptoms at the time of the visit. You should not bill diagnosis code B97.29 or U07.1 in order to be reimbursed for testing.
ICD-10-CM Coding Updates (March 19, 2020 Alert)
The Centers for Disease Control and Prevention (CDC) has issued reporting guidance for Clinical Modification (ICD-10-CM), effective with the next update (October 1, 2020). Full information regarding the new code and the final title will be available soon; we will provide an update as soon as available.

For now, the ICD-10-CM Official Coding Guideline – Supplement Coding Encounters Related to COVID-19 Coronavirus Outbreak (February 20, 2020) provides you with the coding specifications HPSJ is using. They can be found at: https://www.cdc.gov/nchs/icd/icd10cm.htm

Posted on March 25th, 2020 and last modified on April 3rd, 2020.

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