Continuity of Care Information for Providers

Health Plan provides continuity of care for members when their provider is no longer part of the network or when the member is transitioning from Medi-Cal fee-for-service (FFS) to Health Plan or from another managed care plan to HPSJ. Upon request, Health Plan members can continue to see their non-contracted provider for up to 12 months when:

  • Member has an existing relationship with the provider
  • Provider accepts Health Plan’s reimbursement rate or Medi-Cal FFS rates
  • Provider is in good standing and does not have any disqualifying quality of care issues
  • Provider is a California State Plan provider
  • Provider supplies Health Plan all relevant treatment information

Continuity of Care does not apply for services not covered by Medi-Cal, DME, transportation, other ancillary services, or carved-out service providers.

If you are a contracted provider providing services to a Health Plan member you may initiate a request for continuity of care through the provider portal, Medical Authorization Form available on the Health Plan’s website at www.hpsj-mvhp.org, or by contacting Customer Service at (209) 942-6320 or (888) 936-7526.

If you are a non-contracted provider providing services to a Health Plan member you may initiate a request for continuity of care by submitting a Medical Authorization Form available on the Health Plan website at www.hpsj-mvhp.org or by contacting Customer Service at (209) 942-6320 or (888) 936-7526.

Continuity of Care 2024 Transition

Posted on September 14th, 2022 and last modified on January 4th, 2024.

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