The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program- Update
| Date: | June 13, 2024 |
| From: | Health Plan |
| To: | All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Skilled Nursing Facilities |
| Type: | Regulatory |
| Subject: | The Department of Healthcare Services Skilled Nursing Facilities Workforce & Quality Improvement Program- Update |
| Business: | Medi-Cal Managed Care |
The Department of Healthcare Services (DHCS) Skilled Nursing Facilities (SNF) Workforce & Quality Improvement Program (WQIP) incentivizes facilities to improve quality of care, advance equity in healthcare outcomes, and invest in workforce. WQIP functions as a directed payment program in Medi-Cal Managed Care delivery system for eligible network providers.
For more information visit the DHCS website at:
The DHCS will calculate the final payments based on data received as of June 30, 2024.
Encounter File Available
Health Plan would like to inform you that the encounter files related to your facility are now available for review. These files contain important information regarding the services provided to our members during the specified time frame. You can access your file via File Exchange. (Please refer to instructions at the end of the message).
Deadline for Claims Submission to Health Plan
To ensure that your claims are included in the data set and final measurement scores for the second SNF WQIP phase, all claims data should have been submitted to the Health Plan by May 30, 2024. All claims data for service dates between January 1, 2023, and December 31, 2023 should have been included via data File Exchange (Please refer to instructions at the end of the message.) This data will be used for reconciliation purposes. If you haven’t submitted your claims data, please do so as soon as possible.
The reconciliation process will continue until June 30, 2023, during which any errors or discrepancies will be addressed. This is crucial for ensuring accurate payments for the second WQIP (Quality Incentive Program) cycle for Calendar Year 2023.
| Instructions for File Exchange Access and Use |
| 1. DRE Access Requirements
• Register for an Account: Sign up at Doctors Referral Express (DRE) using [this link] (https://provider.hpsj.com/public/acctdre/default.aspx) • Access Request: Providers can request access on or after the contract’s effective date • Availability: The Provider Portal is available 24/7 and is HIPAA compliant
2. FX Access • Login: Visit [DRE Login] (https://provider.hpsj.com) and click on the File Exchange (FX) link
3. First-Time FX Access • Activation Process: o Initially, the user is added as inactive for FX o Contact Provider Services at 209-942-6340 or email [providerservices@hpsj.com] o Activation occurs within 48 hours, granting access to FX from DRE • Automatic Updates: Changes in DRE for name and email are updated in FX
4. FX Inbox/Outbox • Inbox: Shows files uploaded by HPSJ for the provider • Outbox: Shows files uploaded by the provider for HPSJ • Starred Items: Pinned files/templates shared across all providers in the program • File Management: Users can download, delete, or view file activity; pinned files cannot be deleted
5. FX Template/Data File • Download Template: Download the necessary template • Fill Template: Open and complete the template with the required data • Save Template: Save the completed template as a Text (Tab delimited) file
6. FX File Upload • Upload Process: o Open the File Upload Manager dialog o Select File Type and choose the file to upload o Optionally, enter a message and click the Upload button
• Upload Results: Check for any failures in the upload.
7. FX File Activity • Details and Activity: Provides detailed information and activity logs for uploaded files. |
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). In addition, you may send any questions to our LTC email at: LTC@hpsj.com.
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
