Provider Alerts

REMINDER

The Health Plan of San Joaquin (HPSJ) website provides information about programs and services. You can view or download information about the following topics on the website:

• HPSJ’s Case Management program and the process to refer members to case management
  • HPSJ’s Disease Management program and the process to refer members to disease management.
  • Information about Enhanced Care Management (ECM) and how to request access to ECM.
  • Information about Community Supports offered by HPSJ, and how to request access.
  • Information about and member Continuity of Care protections and how to initiate a request for Continuity of Care.
  • Information about and how to request services requiring prior authorization.
• Information about Health Plan of San Joaquin medical necessity criteria, including how to obtain or view a copy
• Information about the availability of staff to answer questions about UM issues
• The toll-free number to contact staff regarding UM issues
• Information about how members may obtain language assistance to discuss UM issues
• The availability of TTY/TDD 711 services for members
• Clinical Practice Guidelines
• Preventative Health Guidelines

HPSJ website Information continued:

• HPSJ’s policy prohibiting financial incentives for utilization management decision makers
• Information about HPSJ’s pharmaceutical management procedures
• A description of the process to review information submitted to support a practitioner’s credentialing application, how to correct erroneous information and, upon request, how to be informed of the status of the credentialing or re-credentialing application
• HPSJ’s member rights and responsibility statement
• Information regarding HPSJ Quality Management Program including performance metrics
• UM decision making is based only on appropriateness of care, services, and existence of coverage.
• HPSJ does not specifically reward practitioners or other individuals for issuing denials of coverage.
• HPSJ’s Affirmative Statement Regarding Utilization Management (UM) Incentives

If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.