Sub Acute FAQ
Will Subacute facilities need a new authorization for members residing in the their facilities if there is already an approved Treatment Authorization Request (TAR) on file from the Department of Health Care Services?
Yes, all patients who transition to HPSJ will need an authorization issued by HPSJ.
What if my facility patient is an HPSJ member but was not part of the data provided by DHCS?
Nursing facilities are required to follow HPSJ’s standard authorization procedures for HPSJ members who are not included in the Subacute data provided by DHCS.
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.
Will HPSJ honor other DHCS approved TARs (excluded from the room and board)?
HPSJ will receive TAR data from DHCS and will contact the affected facilities to verify and arrange for any new authorizations.
What do I do if a bed hold 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.
What documentation is required for Subacute re-authorizations?
When requesting re-authorization, include the most current provider progress note validating the need for continued stay, MD orders, and PASRR for your HPSJ patient.
How far in advance can Subacute authorizations be requested?
Re-authorization can be requested 2-4 weeks prior to the current authorization expiration date date.
Which vendors are contracted for durable medical equipment (DME), 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.
Do we need an Authorization for co-insurance when HPSJ is secondary payer?
Is it ok to bill claims on bi-weekly?
Yes, claims can be billed on a bi-weekly basis.
Does HPSJ accept claims from Office Ally for LTC?
Contact Office Ally to confirm that they can process your LTC claims for HPSJ Members.
How will our facility receive payments?
Change HealthCare (CHC) is HPSJ’s contracted payment vendor. Claim payments are dispersed according to your current set up with CHC.
Should claims typically billed at the beginning of the month include non-covered services (NCS) such as DME equipment, transportation, etc., which are excluded from patient’s share of cost?
Non-covered services (NCS) items must be billed separately.
When billing, do we use ub04 claim form?
Yes, SNF’s should bill LTC services using a ub04 claim form.
How will our facility be reimbursed for physical therapy services?
Physical therapy services are reimbursed as part of the supplemental payment for the first 45 days of admission. After 45 days, authorization must be obtained for additional physical therapy services, and those services must be billed separately.
How should I bill for custodial vs skilled care?
We do not differentiate between the two when it comes to billing. Providers should bill the same revenue codes for all levels of care. Here are the revenue codes you should use:
- 0101 = All Inclusive Room and Board (bill in conjunction with accommodation code 01)
- 0180 = Leave of Absence – General (bill in conjunction with accommodation code 02 or 03)
- 0185 = Bed Hold (bill in conjunction with accommodation code 73)