New systems coming for fraud, waste and abuse capture, as well as claims editing
| To: | Health Plan of San Joaquin (HPSJ) Providers |
| From: | Provider Services Department |
| Subject: | New systems coming for fraud, waste and abuse capture, as well as claims editing |
| Products: | Medi-Cal, AIM |
As part of ongoing oversight efforts, state and federal regulators have mandated that health plans, including HPSJ, adapt new state-of-the-art systems regarding both fraud, waste and abuse capture, as well as claims editing. The purpose behind both systems, operating in tandem, is to ensure efficient plan operations related to claims, without intruding on operations of provider practices.
These systems will be in place by the end of 2015.
There is nothing providers need to do, beyond what your practice is already undertaking for regulatory and legal compliance.
In the coming months we will keep you posted, including, for example, any new messaging you may see once our new internal systems are on line.
If you have any further questions, please contact our Provider Services Department at (209) 942-6340.