Provider Alerts - October 22, 2018

Reminder – Physician Certification Statement (PCS) Form

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Date: October 22, 2018
To: ealth Plan of San Joaquin (HPSJ) Practitioners and Providers
From: HPSJ Medical Management Department
Subject: Reminder – Physician Certification Statement (PCS) Form
Business: Medi-Cal

Spreading the Word, Not the Flu

As we continue to seek ways to streamline processes, Health Plan of San Joaquin has simplified prior authorization requirements for transportation for your busy office.
HPSJ requires a completed Physician Certification Statement (PCS) form to approve transportation for Non -Emergency Medical Transportation (NEMT).

The following items are required:

  • Diagnosis
  • Time frame of transportation needed, this can include multiple visits
  • Clinical indications or documentation to support the medical transportation such as functional limitations with ambulation

Additionally, all authorizations that are approved for NEMT will be valid for the duration of the PCS form, up to six months.

If a member needs additional transportation during the time the PCS is valid, you will not need an additional authorization unless:

  • Transportation provider is different than the original request
  • CPT codes are different
  • Change in patient condition

HPSJ will work with our providers (PCPs and Specialists) to obtain PCS forms on behalf of Transportation agencies. Our HPSJ network providers are important partners in delivering care to our members. We
hope this change will be helpful for you and your practice.

If you have questions, please contact our Customer Service Department at 209.942.6320.

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