Member Billing for Missed Appointments

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Date: May 15, 2019
To: Health Plan of San Joaquin (HPSJ) Providers; HPSJ Customer Service
From: HPSJ Provider Services Department
Subject: Member Billing for Missed Appointments
Business: Medi-Cal

In recent months, we have had inquiries from both providers and members regarding billing members for missed appointments.

Please be aware that the Department of Health Care Services (DHCS) has clarified that under Title 22 CCR 51002, Medi-Cal members cannot be billed for medical services or administrative services related to receiving these services.

Since medical appointments are covered under the Medi-Cal scope of benefits, any charges related to that appointment, including missed appointments, fall under this regulation. This regulation also applies if the member has Medi-Cal as a secondary payor.

If you have any questions or need any further information on this issue, please contact Customer Service at (209) 942-6320.

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Health Plan of San Joaquin is dedicated to providing all members the best health care available in the most effective and efficient manner. Thank you for being one of our valued partners.

REMINDER: If not already submitting your billings electronically (EDI) and not receiving your
payments deposited directly into your bank account (EFT) and receiving your remittance
advice (RA) electronically (ERA), please call your Provider Services Representative today
By signing up for EDI, EFT and ERA services, you typically receive your payments 2-3 days
sooner instead.

CLAIMS CORNER – A (mostly) monthly newsletter brought to you by Health Plan of San
Joaquin. Find timely tips and news at hpsj4.wpengine.com/providers/

Posted on May 15th, 2019 and last modified on May 15th, 2019.

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