October 3, 2023 / by HPSJ / Alerts
Date: October 03, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers Type: Formulary Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective December 11, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code J2327 – INJECTION, RISANKIZUMAB-RZAA, (SKYRIZI), 1 MG: For Acute and Chronic [...]
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Health Plan of San Joaquin provider Alerts
Skilled Nurse Facilities (SNF) / Long Term Care (LTC) Erroneous Denials
October 4, 2023 / by HPSJ / Alerts
Date: October 04, 2023 To: Health Plan of San Joaquin (HPSJ) All Providers and Facilities Type: Regulatory/Informational Subject: Skilled Nurse Facilities (SNF)/ Long Term Care (LTC) Erroneous Denials Business: Medi-Cal Managed Care HPSJ has identified an issue where denial notices were incorrectly issued for “admission date is greater than the statement through date” for all [...]Read more
Medical Benefits Updates
October 3, 2023 / by HPSJ / Alerts
Date: October 03, 2023 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers Type: Formulary Subject: Medical Benefits Updates Business: Medi-Cal Managed Care Effective December 11, 2023, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. 1. Code J2327 – INJECTION, RISANKIZUMAB-RZAA, (SKYRIZI), 1 MG: For Acute and Chronic [...]Read more
Place of Service Billing for Services in FQHCs and RHCs
September 27, 2023 / by HPSJ / Alerts
Date: September 27, 2023 To: Health Plan of San Joaquin (HPSJ) Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) From: Health Plan of San Joaquin (HPSJ) Type: Regulatory Subject: Place of Service Billing for Services in FQHCs and RHCs Business: Medi-Cal Managed Care Effective December 1, 2023, claims for payment of services that [...]Read more
Look and Learn – New HEDIS Portal – Inovalon – Training
September 22, 2023 / by HPSJ / Alerts
Date: September 22, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCPs), Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) From: Health Plan of San Joaquin (HPSJ) Type: Event/Informational Subject: Look and Learn – New HEDIS Portal – Inovalon – Training Business: Medi-Cal Managed Care Health Plan of San Joaquin [...]Read more
DHCS Equity and Practice Transformation Payments Program
September 11, 2023 / by HPSJ / Alerts
Date: September 11, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Provider Organizations From: Health Plan of San Joaquin (HPSJ) Type: Informational Subject: DHCS Equity and Practice Transformation Payments Program Business: Medi-Cal Managed Care On August 30, the California Department of Health Care Services (DHCS) launched the Equity and Practice Transformation (EPT) Provider [...]Read more
Skilled Nursing Facilities (SNF) – Ancillary Billing Guidance
August 23, 2023 / by HPSJ / Alerts
Date: August 23, 2023 To: Health Plan of San Joaquin (HPSJ) Contracted Providers & Facilities From: Health Plan of San Joaquin (HPSJ) Type: Informational Subject: Skilled Nursing Facilities (SNF) - Ancillary Billing Guidance Business: Medi-Cal Managed Care Health Plan of San Joaquin (HPSJ) would like to remind Skilled Nursing Facilities (SNF)/Long Term Care (LTC) providers [...]Read more
Cultural and Linguistic Service Updates
August 23, 2023 / by HPSJ / Alerts
Date: August 23, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Providers, Specialists, Hospitals and Facilities From: Health Plan of San Joaquin (HPSJ) Type: Regulatory/Informational Subject: Cultural and Linguistic Service Updates Business: Medi-Cal Managed Care The Cultural and Linguistics Department of Health Plan of San Joaquin (HPSJ) would like to inform you of [...]Read more
Virtual Look and Learn- August 16, 2023 at 12 PM
August 11, 2023 / by HPSJ / Alerts
Date: August 11, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners and Facilities From: Health Plan of San Joaquin (HPSJ) Type: Event Subject: Virtual Look and Learn- August 16, 2023 at 12 PM Business: Medi-Cal Managed Care Please join us August 16, 2023, from 12:00 pm to 1:30 pm, for a Virtual Provider Look [...]Read more
Reminder for Follow-up After Emergency Department Visit for Mental Illness (FUM) and Follow-up After Emergency (FUA) Department Visit for Substance Use
August 2, 2023 / by HPSJ / Alerts
Date: August 2, 2023 To: Health Plan of San Joaquin (HPSJ) Practitioners and Facilities From: HPSJ Type: Informational/Educational Subject: Reminder for Follow-up After Emergency Department Visit for Mental Illness (FUM) and Follow-up After Emergency (FUA) Department Visit for Substance Use Business: Medi-Cal Managed Care Healthcare Effectiveness Data and information Set (HEDIS) For Measurement Year 2023 [...]Read more
DHCS Equity and Practice Transformation Payments Program
August 2, 2023 / by HPSJ / Alerts
Date: August 2, 2023 To: Health Plan of San Joaquin (HPSJ) Primary Care Provider Organizations From: HPSJ Type: Informational Subject: DHCS Equity and Practice Transformation Payments Program Business: Medi-Cal Managed Care On July 19, 2023 HPSJ hosted a virtual Look and Learn focused on the Department of Health Care Services (DHCS) Equity and Practice Transformation [...]Read more