Provider Alerts

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Date:	October 13, 2016
To:	Health Plan of San Joaquin (HPSJ) Providers
From:	Provider Services Department
Subject:	REMINDERS – (1) No Balance Billing or Surcharge (2) Third Party Liability (TPL)
Business:	Medi-Cal, MCAP (Medi-Cal Access Program, previously known as AIM)

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Per Provider’s contract:

No Balance Billing or Surcharge

• Medi-Cal payment constitutes payment in full per the provider contract with HPSJ, under
  the “No Balance Billing or Surcharge” agreement section.
• Any Surcharge for Covered Services is specifically prohibited for Medi-Cal members, in
  accordance with California Code of Regulations (CCR) Title 22#.
• The provider agrees not to maintain any action at law against a member to collect sums that
  are owed by HPSJ to a provider under the terms of the contract agreement.

Third Party Liability

• Providers are to continue the care for the patient and should not turn away the member
  who possibly has Third Party Liability (TPL).
• Providers have the responsibility to inform HPSJ, when the services are rendered, billed
  and paid for by the Plan, when said services might result in possible TPL. This information is
  captured through claims submission.
  • HPSJ will notify Department of Health Care Services (DHCS) within ten (10) days of
    identifying potentially TPL-related cases.

Any requests received by subpoena from attorneys, insurers, or members for bill copies must be
reported to HPSJ. Copies of the request and responses must be forwarded to:

Health Plan of San Joaquin
7751 S Manthey Rd,
French Camp, CA 95231-9802
Attn: Third Party Liability Coordinator/Claims Department

Upon receipt of a request for information from DHCS, HPSJ must respond within thirty (30)
days. Providers will be contacted if their assistance is needed. The information requested from
providers must be returned within ten (10) days.

If you have any questions, please contact our Provider Services Department at 209-942-6340.

#.Reference:
www.Medi-cal.ca.gov Provider Regulations California Code of Regulations, Title 22
Provider contract section 7.10 & 6.11, HPSJ Provider Manual