Update – Refining Continues for System Identification for fraud, waste and abuse capture, as well as claims editing
| To: | Health Plan of San Joaquin (HPSJ) Providers |
| From: | Provider Services Department |
| Subject: | Update – Refining Continues for System Identification for fraud, waste and abuse capture, as well as claims editing |
| Business: | Medi-Cal, AIM (now known as Medi-Cal Access Program) |
As part of ongoing oversight efforts, state and federal regulators mandate that health plans, including HPSJ, continue to refine and maintain state-of-the-art systems regarding the identification of fraud, waste and abuse capture, as well as claims editing.
The purpose behind both systems, operating in tandem, is to ensure efficient plan operations related to claims, without intruding on operations of provider practices.
Scheduled updates for these systems are progressing and now being tested. They will be operational by early 2016.
There is nothing providers need to do, beyond what your practice is already undertaking for regulatory and legal compliance. HPSJ is working with Optum as our partner for these system updates. In the coming months we will continue to keep you posted, including, for example, any new messaging you may possibly see once our updated internal systems are on line.
If you have any further questions, please contact our Provider Services Department at (209) 942-634.