Improving Encounter Submission
| Date: | October 02, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Therapeutics Committee |
| To: | Health Plan Primary Care Providers – Capitated PCP’s |
| Type: | Procedural Update |
| Subject: | Improving Encounter Submission |
| Business: | Medi-Cal Managed Care |
Health Plan introduced new Primary Care Provider (PCP) capitation payment rates in December 2024 based on utilization experience identified through encounters and claims paid.
Health Plan’s goal is to reevaluate the capitation reimbursement on an annual basis and adjust rates based on encounters. But first, we want to partner with you to improve encounter submission to ensure the care you provide is accurately captured in the data we receive.
Accurate and timely encounter submission plays an important role in supporting reimbursement, Healthcare Effectiveness Data and Information Set (HEDIS) performance, and overall quality outcomes.
To help capture timely and accurate encounter data, we are enhancing the encounter submission process, making it easier. This will improve completeness and accuracy, while identifying opportunities to reduce challenges and delays.
What to expect as part of the improvement process:
- A follow up communication with more details on your capitation rates later this month.
- A dedicated informational and Q&A session in November (invitations with session details to follow)
- Training in encounter submission requirements and best practices
- Education and resources to help improve accuracy and completeness
- Identification of common submission issues and opportunities for improvement
- Ad hoc training sessions available upon request
- Feedback and support to help strengthen encounter submissions
- Monitoring progress and working with you for improvement
We look forward to partnering with you in this improvement journey and supporting your teams every step of the way. Additional information regarding training, resources, and next steps will be shared soon.
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
