Provider Alerts

Health Plan is providing an update on the Department of Healthcare Services (DHCS) Skilled Nursing Facilities (SNF) Workforce & Quality Improvement Program (WQIP). As a directed payment program in Medi-Cal Managed Care delivery system for eligible network providers, Health Plan has provided you with a DHCS encounter file to assist with reconciling bed days for WQIP scoring and payment purposes.

You can access your facility’s data on File Exchange via Doctors Referral Express (DRE). These files contain important information regarding the services you provided to our members for Calendar Year (CY) 2023. This is your opportunity to review the data and make any corrections needed to ensure accurate calculations for the SNF WQIP CY 2023 final payment.

Action Required

1. Download the encounter file from File Exchange under Inbox, User Program: WQIP DHCS Reconciliation.
2. Review the encounter file and reconcile it against your records.
3. To make any corrections:
   1. Update existing encounter data that is incorrect by making the changes on the spreadsheet
   2. Add additional rows at the bottom of the spreadsheet to include encounter data that is missing. If the encounter data has never been submitted, submit your claims immediately.
4. Ensure all headers on the spreadsheet remain the same and the following nine fields must be populated, or the file will be rejected by the system, File Exchange:

• Facility_Name
• NPI
• AKA_CIN
• BIRTH_DT
• SVC_FROM_DT
• SVC_TO_DT
• PROC_CD
• REVENUE_CD
• WQIP_Days

5. Once you have finished reconciling the encounter file and documenting the corrections on the spreadsheet, upload the file back to File Exchange.

Upload Process:

• Select Outbox
• Select User Program: WQIP Provider Reconciliation
• Select Upload File icon to open the File Upload Manager
• Select Choose File. Select the file you want to upload
• Select Upload

You should receive a successful file upload result.

Deadline for Encounter Submission to Health Plan

The original bed day data reconciliation deadline was scheduled for June 30, 2024. DHCS has communicated this deadline is no longer in effect and they will be communicating a new deadline soon. In the meantime, please submit any missing or incorrect encounter submissions for CY 2023 as soon as possible as we do not know how long the window of opportunity will be in effect.

If you need access to File Exchange, you must login to DRE and click on the File Exchange link.

• This will prompt a notification that user is not authorized to access File Exchange and to contact Provider Services.
• Email providerservices@hpsj.com to have access enabled.
• Provider Services will grant access and notify you.

For more information on WQIP, visit the DHCS website at:

https://www.dhcs.ca.gov/services/Pages/SNF-WQIP.aspx

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