Provider Policies - HPSJ/MVHP

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This section of our website is dedicated to supporting Health Plan of San Joaquin / Mountain Valley Health Plan (“Health Plan”) providers with valuable tools and resources on current policies.

Quality Management

Dec 23rd, 2024 QM38 Quality Management Utilization Management Committee Dec 23rd, 2024 QM37 Fair Hearing Process for Adverse Actions Resulting in Mandatory Reportable Actions Dec 23rd, 2024 QM18 Interrater-Reliability Process - Medical Record Review HEDIS Audits Dec 23rd, 2024 QM17 External Quality Review Requirements. Dec 23rd, 2024 QM14 Facility Access for Physically Disabled Members Dec 23rd, 2024 QM07 Reporting of diseases and conditions to Public Health Authorities Dec 23rd, 2024 CM67 Major Organ Transplant Mar 31st, 2017 QM38 Quality Management _ Utilzation Management Committee _ QM-UMC Mar 31st, 2017 QM37 Fair Hearing Process for Adverse Actions Resulting in Mandatory Reportable Actions Mar 31st, 2017 QM18 Interrated-Reliability Process - Medical Record Review, HEDIS Audits Mar 31st, 2017 QM17 External Quality Review Requirements Mar 31st, 2017 QM14 Facility Access for Physically Disabled Members Mar 31st, 2017 QM07 Delegation of QI Mar 31st, 2017 Form31 PPC Reporting Form Mar 31st, 2017 Form29 Medical Record Review Survey Tool Mar 31st, 2017 Form28 Full Scope Site Review Survey Tool Mar 31st, 2017 Form27 Inter-Rater Reliability Audit Form Mar 31st, 2017 Form25 Potential Quality Issue Report Form Mar 31st, 2017 Form24 Practitioner 2168 Fax Back Form - HIV_AIDS Specialist Designation Request Mar 31st, 2017 Form22 HPSJ QI Audit Data Collection Summary Report Mar 31st, 2017 Form 33 Reporting Instructions

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Utilization Management

Dec 23rd, 2024 UM66 Communication to Members and Providers Regarding UM Issues Dec 23rd, 2024 UM55 Emergency Transportation and NEMT. Dec 23rd, 2024 UM40 Dental Services Dec 23rd, 2024 UM07 Notice of Action for Delayed, Denied, Modified, or Terminated Services Dec 23rd, 2024 UM05 Over-Under Utilization of Services Monitoring Dec 23rd, 2024 UM02 Inpatient authorization and Concurrent Review Dec 23rd, 2024 UM 69 Provider Preventable Condition Monitoring and Reporting Mar 31st, 2017 UM69 Provider - Preventable Condition Monitoring and Reporting Mar 31st, 2017 UM67 Use of Board Certified Physicians Making Medically Necessary Determinations Mar 31st, 2017 UM66 Communication to Members and Providers Regarding UM Issues Mar 31st, 2017 UM56 Vision Care Mar 31st, 2017 UM55 Transportation Services Mar 31st, 2017 UM46 Attachment A - Components of Screening Mar 31st, 2017 UM46 Alcohol and Substance Abuse Treatment Services Mar 31st, 2017 UM40 Dental Care and Dental Anesthesia Mar 31st, 2017 UM07 Notice of Action for Delayed, Denied, Modified, or Terminated Services Mar 31st, 2017 UM05 Over - Under Utilization of Services Monitoring Mar 31st, 2017 UM04 Emergency Department Services Mar 31st, 2017 UM02 In Patient Admissions and Concurrent Review

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Posted on March 31st, 2017 and last modified on January 23rd, 2025.

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