Provider Alerts

Health Plan of San Joaquin (HPSJ) would like to remind you about our website http://www.hpsj.com. We include information about many topics of interest on our website. You can view and/or download information about the following topics on the website:

• The process to refer members to case management.
• Information about Health Plan of San Joaquin 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.
• Information about Health Plan of San Joaquin 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 Health Plan of San Joaquin’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 recredentialing application.
• Health Plan of San Joaquin member rights and responsibility statement
• Clinical Practice Guidelines
• Preventative Health Guidelines
• Information about how members may obtain language assistance to discuss UM issues.
• The toll-free number to contact staff regarding UM issues
• The availability of TTY/TDD 711 services for members
• Information about how members 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.
• A description of the process to review information submitted to support a practitioner’s credentialing application, how to correct erroneous information and, upon request, how to be informed of the status of the credentialing or re-credentialing application.
• HPSJ’s member rights and responsibility statement
• Information regarding HPSJ Quality Management Program including performance metrics.

HPSJ’s Affirmative Statement Regarding Utilization Management (UM) Incentives

• UM decision making is based only on appropriateness of care, services, and existence of coverage.
• HPSJ does not specifically reward practitioners or other individuals for issuing denials of coverage.
• Financial incentives for UM decision makers do not encourage decisions that result in underutilization.

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 Health Plan of San Joaquin and our services is always available on our website www.hpsj.com.