Provider Alerts - December 13, 2018

Incentive Claims – Important Reminder

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Date: December 13, 2018
To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCP)
From: Provider Services Department
Subject: Incentive Claims – Important Reminder
Business: Medi-Cal

Action Now

Our HPSJ providers are important partners in delivering care to our members. Because of your valued contribution, we are sending this additional reminder to get all of your claims in as early as possible for calendar year 2018. This will help ensure that your incentive measure claims are in the HPSJ database before the end of the year.

This is a reminder of the measures for 2018:

PCPs

  • Initial Health Assessment
  • Annual Monitoring for Patients on Persistent Medications (ACE or Arbs)
  • Annual Monitoring for Patients on Persistent Medications (Diuretic)
  • Cervical Cancer Screening
  • Children and Adolescents’ Access to Primary Care Practitioners 12-24 mo.
  • Children and Adolescents’ Access to Primary Care Practitioners 7-11 yrs.
  • Children and Adolescents’ Access to Primary Care Practitioners 12-19 yrs
  • Diabetic eye exam
  • Diabetic HgA1c
  • Immunizations for Adolescents (3 required, Meningococcal, Tdap and HPV 13 yr. old)
    Weight assessment and counseling for Nutrition and Physical Activity for Children and Adolescents

    • BMI percentile
    • Counseling for Nutrition
    • Counseling for Physical Activity
  • Well-Child visits 3 – 6 yrs

OB/GYN or PCP (provider of service)

  • Prenatal care – first trimester or within 42 days of assignment to plan
  • Postpartum care – between 21-56 days after delivery.

Please send any claims for inclusion in the 2018 year soon. There may be a back log at the end of the year so the sooner, the better.
If you have questions, please contact our Customer Service Department at 209-942-6320

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