Provider Manual

Health Plan of San Joaquin (HPSJ) is pleased to have you as part of our provider network. We recognize that the strength of our health care programs depends upon strong collaboration and communication with our providers, practitioners and their staff.   The Provider Manual is intended to be a useful guide for participating providers/practitioners with HPSJ.

For the purposes of the Provider Manual, “provider” refers to health care practitioners and providers including any physician, nurse, other health care practitioner, hospital, ancillary provider, or other person or institution that furnishes Covered Services.

View or download individual sections

If you would like to download each section on its own, please click on the “PDF Download” button. You can also download the Quick Reference Guide here.

Section 1: Introduction
Section 2: Benefit Program
Section 3: Provider Credentialing
Section 4: Provider Contracting
Section 5: Provider Services
Section 6: Eligibility, Enrollment, and Disenrollment
SecSection 7: Provider–Member Relationship
Section 8: Utilization Management
Section 9: Care Coordination
Section 10: Claims Submission
Section 11: Provider Payments
Section 12: Dispute Resolution
Section 13: Quality Management and Improvement
Section 14: Pharmacy Services
Section 15: Behavioral Health
Section 16: Regulatory Compliance

Posted on October 3rd, 2016 and last modified on July 16th, 2019.

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