Provider Alerts

The following is an update regarding the future of the Value Based Payment (VBP) program.

As you may know, the Proposition 56 VBP program ended on June 30, 2022, by the California Department of Health Care Services (DHCS). Please note that only the supplemental payments focused on eligible contracted providers meeting specific measure achievements in areas such as behavioral health integration; chronic disease management; prenatal/post-partum care; and early childhood prevention ended.

While the Proposition 56 VBP program was terminated by DHCS, HPSJ has decided to continue the VBP program for the current fiscal year. The program will be funded directly by HPSJ. There are no plans to change program measures currently. Visits after dates of service (DOS) June 30, 2022, will continue to be eligible for the VBP supplemental payment. The program continuance is at the sole discretion of HPSJ.

At present, HPSJ is working to configure its payment system to allow the program continuation beyond June 30, 2022. This may result in a delayed payment as we are working through this change.

HPSJ is requesting that claims be submitted timely. HPSJ will periodically provide updates to the VBP program site (https://www.hpsj.com/value-based-payments/), we encourage our providers to review it regularly.

As stated in the HPSJ Provider Manual, timely filing guidelines for claims submission is three hundred and sixty-five (365) days from the date of service. If a claim is received after the appropriate time frame, the claim will be denied unless disputed pursuant to C.C.R. Section 1300.71.38 and a good cause for delay as defined can be presented. For more information, please review Section 10 of the HPSJ Provider Manual (https://www.hpsj.com/provider-manual/).

If you have further questions about the VBP program –– please contact the HPSJ Claims Department via the email address: SupplementalPayments@HPSJ.com. Please allow two business days for a response.