Will Intermediate Care Facilities (ICF) need a new authorization for members residing in their facilities if there is an approved Treatment Authorization Request (TAR) on file from Department of Health Care Services (DHCS)?
Yes. All members in the ICF will require authorization issued by HPSJ. However, HPSJ will honor any TARS currently active at the time of transition up until the expiration date or 1 year, whichever is soonest.
How do I submit an authorization for HPSJ members?
Authorization requests must be submitted electronically through Doctor’s Referral Express, HPSJ’s the provider portal. Visit www.hpsj.com/providers to login or create a new account.
You may also submit an authorization request by secure fax to (209) 762-4702. If submitted by fax, include the current authorization request form.
Supporting clinical documentation must be included for electronic or faxed authorization requests.
What do I do if a bedhold or LOA is needed?
Whenever an HPSJ member is transferred/discharged from the facility you must notify HPSJ of the transition. For transfers to the acute hospital, submit a request for authorization of a bed hold online using Doctor’s Referral Express, www.hpsj.com/providers or by sending the authorization request form by fax to (209) 762-4702.
How will authorization information be communicated to the facility if we do not have access to HPSJ’s Provider Portal (Doctor’s Referral Express)?
The facility will receive fax notification of the authorization information.
How far in advance can re-authorizations be requested?
Re-authorization can be requested 2-4 weeks prior to the current authorization expiration date.
Which vendors are contracted for durable medical equipment (DME) – such as lab, x-ray, oxygen, pharmacy, and podiatry?
A list of HPSJ contracted providers can be found using HPSJ’s provider search tool located at: www.hpsj.com/find-a-provider Pharmacy benefits are administrated by DHCS through Medi-Cal RX and can be found on the Medi-Cal RX website: www.medi-calrx.dhcs.ca.gov/home. View tools and resource section.
What documents are needed for an authorization?
Facility Facesheet, MD orders, HS 231, TAR – if applicable.
Will HPSJ honor DHCS approved TARs?
TARs will honored until the expiration date or 1 year whichever is soonest. In cases where the expiration date is further out than 1 year please re-submit the TAR with the re-authorization request.