Update: Claims Processing System Upgrade – QNXT 2.0 Go-Live Moved to 8/15/2025
| Date: | July 15, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Providers, Facilities and Hospitals |
| Type: | Informational |
| Subject: | Update: Claims Processing System Upgrade – QNXT 2.0 Go-Live Moved to 8/15/2025 |
| Business: | Medi-Cal Managed Care |
Health Plan recently announced that our current claims processing system will be upgraded to QNXT 2.0. The go-live date has been moved from July 25, 2025, to August 15, 2025. This upgrade is aimed at streamlining claims processing and enhancing overall operational efficiency.
Next Steps:
As part of the QNXT 2.0 upgrade, Health Plan will pause adjudication of new claims from July 28 through August 14, 2025. Claims received on or before July 27, 2025, will continue to be processed during this time. During this time, you do not need to stop your claims submission to Health Plan and can continue to submit as normal.
Health Plan is actively working to process all claims, including backlog items, to ensure that any claims received before the system cutover are completed prior to the QNXT 2.0 go-live weekend (scheduled for August 15, 2025). As the claims inventory is closed out, you may notice variations in payment amounts. All claims will continue to be processed within forty-five (45) working days from the date of complete submission. The first check run after go-live is scheduled for August 19, 2025.
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
