Update: Cost Avoidance and Post Pay Recoveries – DHCS Intervention
| Date: | September 4, 2020 |
| To: | Health Plan of San Joaquin (HPSJ) All Practitioners and Facilities |
| From: | Health Plan of San Joaquin |
| Subject: | Update: Cost Avoidance and Post Pay Recoveries – DHCS Intervention |
| Business: | Medi-Cal Managed Care |
The California State Law requires Medi-Cal and Managed Care Plans (MCP’s) to be the payer of last resort for services in which there is a responsible third-party, Other Healthcare Coverage (OHC). While Health Plan of San Joaquin’s (HPSJ) current policy reflects the requirement, new guidelines are being presented by the California Department of Healthcare Services (DHCS) to ensure both providers and MCP’s are doing their part to correctly identify OHC and avoid unnecessary costs.
In accordance with DHCS All Plan Letter (APL) 20-010, all identified overpayment related to member(s) having Other Healthcare Coverage (OHC) and/or California Children’s Services (CCS) eligible condition at the time services are rendered will be reported to DHCS. Any overpayments which are not reimbursed to HPSJ by the thirteenth (13th) month of the paid date of the claim will be pursued and collected by DHCS and/or assigned collections contractor.
What can you do to avoid DHCS collections?
- Ensure front end staff validates eligibility for members at each visit through the
Medi-Cal Eligibility Portal. https://www.medi-cal.ca.gov/Eligibility/Login.asp - Respond to any Recovery Demands sent by HPSJ within the allocated timeframe.
- Return any overpayment to HPSJ within thirty (30) business days after the date on which the overpayment was identified (APL 17-003) and/or immediately after OHC is identified.
If you have questions, please contact our Customer Service Department at 209.942.6320.