Provider Alerts - December 4, 2018

Proposition 56: Supplemental Payment UPDATE

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Date: December 4, 2018
To: Health Plan of San Joaquin (HPSJ) PCPs and Specialists
From: HPSJ Claims Department
Subject: Proposition 56: Supplemental Payment UPDATE
Business: Medi-Cal

IMPROVED PROCESS

We understand that paying the supplemental payment through your contracted rate has had its challenges. Therefore, we have improved the process. Health Plan of San Joaquin will no longer pay the Prop 56 supplemental benefit for claims with a date of service from 12/01/2018 forward through the claims processing system.

New process:

  • Claims received that fall under Prop 56 with a date of service 12/01/2018 forward will be paid monthly on a separate check with a readable file attached for reconciliation purposes.
    • Payments will reflect the new rates on the old codes and include the preventative visit codes added this year.

Old process:

  • Claims received that fall under Prop 56 with a date of service 07/01/2017 through 11/30/2018 will continue to pay through the claims system and do not include the new supplemental payment.
    • We will begin a true-up on these claims outside the system following the new process.

For information on codes and rates, please refer to the Provider Alert dated October 30, 2018.

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. If you have questions, please contact our Customer Service Department at 209-942-6320.

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.

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