Reminder: Valid Authorization Required on Claims
| Date: | October 28, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Providers, Facilities and Hospitals |
| Type: | Informational |
| Subject: | Reminder: Valid Authorization Required on Claims |
| Business: | Medi-Cal Managed Care |
Health Plan would like to remind providers about including the authorization number on the claim when prior authorization is required and has been obtained. To avoid having your claim denied for invalid or missing authorization number, please follow the billing guidelines below for proper submission and reimbursement.
- CMS1500: For services requiring prior authorization, include a valid authorization number on the claim, Box 23, and ensure it is for the same member, provider, service, and has not already been used or voided.
- UB04: For services requiring prior authorization, include a valid authorization number on the claim, Box 63, and ensure it is for the same member, provider, service, and has not already been used or voided.
- Only one authorization number can be included on a claim.
- Multiple claims must be submitted for services that have more than one authorization.
- If no authorization is required, leave the prior authorization field blank. Entering any information other than a valid authorization number will result in a claim denial.
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 and our services is always available on our website www.hpsj-mvhp.org
