May 17, 2024 / by HPSJ / Alerts
Date: May 15, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Laboratory Providers and Inpatient/Outpatient Facilities Type: Regulatory Subject: Laboratory Test in Hospital Business: Medi-Cal Managed Care Through the new Claims Editing System (CES), Health Plan has identified when billing laboratory codes, the concept of professional and technical [...]
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Health Plan of San Joaquin provider Alerts
Emergency Department/Room Type of Bill Requirement
May 17, 2024 / by HPSJ / Alerts
Date: May 15, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Hospital Outpatient Facilities Type: Regulatory Subject: Emergency Department/Room Type of Bill Requirement Business: Medi-Cal Managed Care Through the new Claims Editing System (CES), Health Plan has identified that an incorrect Type of Bill is being used when [...]Read more
Surgery – Billing with Modifiers
May 17, 2024 / by HPSJ / Alerts
Date: May 15, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Providers Type: Regulatory Subject: Surgery – Billing with Modifiers Business: Medi-Cal Managed Care As you are aware, Health Plan is changing to a new Claims Editing System (CES). Health Plan has identified the most significant changes and [...]Read more
Telehealth: Required Modifier and Place of Service
May 17, 2024 / by HPSJ / Alerts
Date: May 15, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Providers and Practitioners Type: Regulatory Subject: Telehealth: Required Modifier and Place of Service Business: Medi-Cal Managed Care Through the new Claims Editing System (CES), Health Plan identified the required modifier is missing, or the modifier billed is [...]Read more
Laboratory Test in Hospital
May 17, 2024 / by HPSJ / Alerts
Date: May 15, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Laboratory Providers and Inpatient/Outpatient Facilities Type: Regulatory Subject: Laboratory Test in Hospital Business: Medi-Cal Managed Care Through the new Claims Editing System (CES), Health Plan has identified when billing laboratory codes, the concept of professional and technical [...]Read more
Claims Editing System (CES) Go-Live May 17
May 17, 2024 / by HPSJ / Alerts
Date: May 15, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Providers and Facilities Type: Informational Subject: Claims Editing System (CES) Go-Live May 17 Business: Medi-Cal Managed Care Reminder: Health Plan is implementing new institutional claims editing processes. We are enhancing our existing, internally developed claims editing processes, [...]Read more
Medical Nutrition Therapy (MNT)
May 9, 2024 / by HPSJ / Alerts
Date: May 08, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Providers Type: Regulatory Subject: Medical Nutrition Therapy (MNT) Business: Medi-Cal Managed Care Health Plan provides Medical Nutrition Therapy (MNT) to our members in accordance with Department of Health Care Services (DHCS) and our Medical Nutrition Therapy guidelines. [...]Read more
Health Plan Grant Opportunities
May 8, 2024 / by HPSJ / Alerts
Date: May 08, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Providers Type: Informational Subject: Health Plan Grant Opportunities Business: Medi-Cal Managed Care Health Plan is proud to announce its investment of $100 million in a three-year Community Reinvestment Program. The following grant opportunities are included: Health Information [...]Read more
Eye Injections Reference Sheet for Ophthalmologists
May 1, 2024 / by Araceli Gallo / Alerts
Date: May 1, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Ophthalmologists Type: Informational/Educational Subject: Eye Injections Reference Sheet for Ophthalmologists Business: Medi-Cal Managed Care The Pharmacy and Therapeutics (P&T) Committee previously provided medical benefit updates in the Provider Alert issued in April of 2024. As a result, [...]Read more
Reminder: Department of Healthcare Services Skilled Nursing Facilities Workforce and Quality Improvement Program
May 1, 2024 / by Araceli Gallo / Alerts
Date: May 1, 2024 From: Health Plan To: All Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) Skilled Nursing Facilities Type: Regulatory Subject: Reminder: Department of Healthcare Services Skilled Nursing Facilities Workforce and Quality Improvement Program Business: Medi-Cal Managed Care This is a reminder that the Department of Healthcare Services (DHCS) Skilled Nursing [...]Read more
DMHC APL 23-025 and Assembly Bill (AB) 254 – Confidentiality of Medical Information Act: Reproductive or Sexual Health Application Information
May 1, 2024 / by Araceli Gallo / Alerts
Date: May 1, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan ("Health Plan") To: Health Plan Providers Type: Regulatory Subject: DMHC APL 23-025 and Assembly Bill (AB) 254 - Confidentiality of Medical Information Act: Reproductive or Sexual Health Application Information Business: Medi-Cal Managed Care On February 7, 2024, the Department of Managed Health [...]Read more