Provider Alerts

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To:	Health Plan of San Joaquin (HPSJ) Physicians, Providers, and Pharmacies
From:	Provider Services Department

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As a valued Health Plan of San Joaquin (HPSJ) provider, we would like to remind you about all of the important information, tools and materials that you can access from our website. We include information about many topics of interest on our website. You can view and/or download information about the following topics at hpsj.com.

• Information about HPSJ’s Quality Improvement Program including goals, processes and outcomes as related to care and service.
• The process for practitioners, facility staff, including discharge planners, to refer members to case management.
• The process to refer members to disease management.
• Information about disease management programs, including how to use the services and how HPSJ works with a practitioner’s patients in the program.
• Information about how to obtain or view copies of HPSJ’s specific adopted clinical practice guidelines and preventive health guidelines, including those for:
  • Clinical Practice Guidelines:
    • Attention deficit hyperactivity disorder (ADHD)
    • Asthma
    • Chronic Obstructive Lung Disease (COPD)
    • Depression
    • Diabetes
    • Heart Failure
  • Preventative Health Guidelines:
    • Pediatrics (age 0-19), Preventative Pediatric Health Care
    • Pediatrics (age 0-19), Immunization Recommendations for ages 0-19
    • Perinatal Care
    • Adults (age 20-64), Preventative care for ages 19 years and older
    • Geriatrics (age 65+), Fall precautions for ages 65-older
• Information about HPSJ’s medical necessity criteria, including how to obtain or view a copy.
• Information about the availability of staff to answer questions about UM issues.
• The toll-free number to contact staff regarding UM issues.
• The availability of TDD/TTY services for members.
• Information about how members may obtain language assistance to discuss UM issues.
• HPSJ’s policy prohibiting financial incentives for utilization management decision-makers.
• Information about HPSJ’s pharmaceutical management procedures including our drug list along with restrictions and preferences; how to use pharmaceutical management procedures; an explanation of limits and quotas; how practitioners can provide information to support an exception request; and HPSJ’s processes for generic substitution, therapeutic interchange, and step-therapy.
• A description of the process to review information submitted to support a practitioner’s credentialing application, correct erroneous information and, upon request, to be informed of the status of the credentialing or re-credentialing application.
• HPSJ’s member rights and responsibilities statement.

If you have any questions about accessing our website or if you would like more information, please call the Provider Relations Department at (209) 942-6340. The most recent information about HPSJ and our services is always available on our website.