Provider Alerts

As a reminder, Health Plan launched a Medicare Advantage Dual Special Needs Plan (D-SNP) starting 01/01/2026, as Health Plan of San Joaquin/Mountain Valley Health Plan Advantage D-SNP (HMO). This new plan serves members who are eligible for both Medicare and Medi-Cal known also as Medi-Medi members.

We have become aware of an enrollment scenario affecting some members, in which their Medicare assignment is with HPSJ/MVHP Advantage D-SNP but their Medi-Cal assignment is not. Therefore, D-SNP members assigned to HPSJ/MVHP Advantage D-SNP may reflect a different Medi-Cal plan.

For Medi-Medi members enrolled in HPSJ/MVHP Advantage D-SNP, who do not have HPSJ/MVHP Medi-Cal Health Plan, when a claim is received:

• The claim will be processed under the D-SNP line of business only.
• Providers will receive a D-SNP payment and remit notice indicating that the claim must be submitted to the member’s appropriate Medi‑Cal plan for review and processing.
• Members must not be billed for any portion of these services.

Important:
Federal and state regulations prohibit billing Medi-Cal members for services that should be covered under their Medi‑Cal benefits. Billing Medi-Cal members violates federal law as outlined in section 1902(n)(3)(B) of the Social Security Act, as modified by section 4714 of the Balanced Budget Act of 1997. Any remaining balance must be directed to the correct Medi‑Cal line of business, not to the member.

For questions regarding Medi‑Cal plan assignment, please verify eligibility through your standard eligibility tools or contact your Provider Services Representative.

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