The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program – File Reconciliation Calendar Year 2024
| Date: | April 29, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Skilled Nursing Facilities |
| Type: | Regulatory |
| Subject: | The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program – File Reconciliation Calendar Year 2024 |
| Business: | Medi-Cal Managed Care |
Health Plan is providing an update on the Department of Healthcare Services (DHCS) Skilled Nursing Facilities (SNF) Workforce & Quality Improvement Program (WQIP), a directed payment program in the Medi-Cal Managed Care delivery system.
To support your facility in reviewing and correcting encounter data for accurate WQIP scoring and payment, Health Plan has provided a DHCS encounter file for Calendar Year 2024 (CY24). This file is accessible via File Exchange on Doctors Referral Express (DRE) and contains details on qualifying bed days provided to our members in CY24.
Action Required:
- Download your facility’s encounter file from the Health Plan File Exchange portal via the DRE Provider Portal.
- Navigate to File Exchange and locate your file under Inbox, User Program: WQIP DHCS Reconciliation.
- If any discrepancies or missing qualifying bed days are identified:
- Verify that your claims were submitted and paid by Health Plan.
- If claims were not paid or submitted, submit a corrected claim through your clearinghouse as part of your normal submission process.
- There is no need to upload revised spreadsheets back to the portal.
Note: If you are unable to access File Exchange-
- Login to the DRE Provider Portal and click on the File Exchange link.
- You will be prompted with an unauthorized access message.
- Email Provider Services at providerservices@hpsj.com for assistance.
- Provider Services will grant access and notify you.
Additional Information:
DHCS has communicated that the deadline for any additional encounter submission is June 30, 2025. Therefore, please submit your corrected claims, if any, as soon as possible to allow for claims processing timelines. If claims have been paid but are not in the DHCS encounter file provided, please contact your Provider Services Representative as soon as possible.
For more information on WQIP, visit the DHCS website at:
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
