Provider Alerts

Effective February 20, 2024, the elective admission precertification process for Health Plan has changed. The previous process of a provider submitting an authorization request for an elective admission and the concurrent stay being reviewed all under one certification number is no longer in effect. The updated elective admission precertification process is as follows:

1. The requesting provider submits a request for an elective admission.
2. The Authorizations and Referrals Department at Health Plan reviews the request, and a determination is made.
3. The precertification is then closed and remains valid through the approved period. The determination is communicated with the provider (and member) per regulatory requirements.
4. Upon admission, the hospital submits an admission notice to the Inpatient Department via fax (209-762-4702) or the Provider Portal.
   1. Please make note of the precertification number on the admission notice fax or in the Provider Portal request submission.
5. Upon receipt of admission notification, the Inpatient Department creates a new certification and links it to the completed precertification.
6. After discharge, the Inpatient Department closes the inpatient certification, and the final determination is communicated with the provider.
7. The provider will submit a claim that includes the inpatient certification number.

If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG