June 30, 2022 / by HPSJ / Alerts
Date: June 30, 2022 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers From: Health Plan of San Joaquin Pharmacy and Therapeutics Committee Subject: Medical Benefit Updates Business: Medi-Cal Managed Care Effective September 5, 2022, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit: Code J2357 - INJECTION, OMALIZUMAB [...]
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Health Plan of San Joaquin provider Alerts
Revised DHCS Facility Site Review and Medical Record Review Tools and Standards
July 1, 2022 / by HPSJ / Alerts
Date: July 1, 2022 To: Health Plan of San Joaquin (HPSJ) PCP’s and FQHCs From: HPSJ Quality Management Department Type: Informational/Regulatory Subject: Revised DHCS Facility Site Review and Medical Record Review Tools and Standards Business: Medi-Cal Managed Care Beginning July 1, 2022, the Department of Health Care Services (DHCS) will be implementing the use of [...]Read more
2022 Mandatory Annual Trainings Final Reminder
July 1, 2022 / by HPSJ / Alerts
Date: June 30, 2022 To: Health Plan of San Joaquin (HPSJ) Practitioners, Providers & Facilities From: Health Plan of San Joaquin Subject: 2022 Mandatory Annual Trainings Final Reminder Business: Medi-Cal ACTION REQUIRED Please complete ALL THREE trainings by June 30, 2022 Annual training is mandated by California’s Department of Health Care Services (DHCS) and the [...]Read more
Medical Benefit Updates
June 30, 2022 / by HPSJ / Alerts
Date: June 30, 2022 To: Health Plan of San Joaquin (HPSJ) Physicians and Providers From: Health Plan of San Joaquin Pharmacy and Therapeutics Committee Subject: Medical Benefit Updates Business: Medi-Cal Managed Care Effective September 5, 2022, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit: Code J2357 - INJECTION, OMALIZUMAB [...]Read more
Reminder: Phase 2: ECM and Community Supports – San Joaquin and Stanislaus Counties
June 30, 2022 / by HPSJ / Alerts
Date: June 30, 2022 To: HPSJ Primary Care Providers, Specialists, Hospitals and Facilities From: Health Plan of San Joaquin Subject: Reminder: Phase 2: ECM and Community Supports – San Joaquin and Stanislaus Counties Business: Medi-Cal Enhanced Care Management and Community Supports Starting in January of 2022, new benefits and services called Enhanced Care Management (ECM) [...]Read more
2022 Mandatory Annual Training – Reminder Table
June 29, 2022 / by HPSJ / Alerts
Type of Training Requirement Due Date Health Insurance Portability and Accountability Act (HIPAA) HIPAA is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to […]
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DHCS APL 21-014 Requirements – Clarification of Requirements
June 17, 2022 / by HPSJ / Alerts
Date: June 16, 2022 To: Health Plan of San Joaquin Practitioners, Contracted Providers, Facilities, and Behavioral Health Providers From: Health Plan of San Joaquin Subject: DHCS APL 21-014 Requirements – Clarification of Requirements Business: Medi-Cal Health Plan of San Joaquin (HPSJ) received All Plan Letter (APL) 21-014 from the Department of Health Care Services (DHCS) [...]Read more
REMINDER – Confidentiality of Medical Information
June 17, 2022 / by HPSJ / Alerts
Date: June 16, 2022 To: Health Plan of San Joaquin Practitioners, Contracted Providers and Facilities From: Health Plan of San Joaquin Subject: REMINDER – Confidentiality of Medical Information Business: Medi-Cal OPL 22-010 (Office of Planning Licensing); guidance regarding Assembly Bill (AB) 1184 – confidentiality of medical information, from the Department of Managed Health Care (DMHC) [...]Read more
Provider Dispute Resolution Submission Reminder
June 15, 2022 / by HPSJ / Alerts
Date: June 15, 2022 To: Health Plan of San Joaquin (HPSJ) All Providers & Facilities From: Health Plan of San Joaquin Subject: Provider Dispute Resolution Submission Reminder Business: Medi-Cal Managed Care It has been identified that the incorrect dispute type continues to be selected when submitting a Provider Dispute Resolution (PDR) through the DRE portal. [...]Read more
Prior Authorization Requests Related to Cancer Treatment
June 1, 2022 / by HPSJ / Alerts
Date: May 31, 2022 To: Health Plan of San Joaquin Facilities and Oncologists From: Health Plan of San Joaquin Subject: Prior Authorization Requests Related to Cancer Treatment Business: Medi-Cal For submissions of Prior Authorization Requests Related to Cancer Treatment, the following components must also be provided for review. If any required pieces of information are [...]Read more
Non-Emergency Medical Transportation
May 11, 2022 / by HPSJ / Alerts
Date: May 11, 2022 To: Health Plan of San Joaquin (HPSJ) Practitioners, Providers and Facilities From: Health Plan of San Joaquin Subject: Non-Emergency Medical Transportation Business: Medi-Cal Managed Care Non-emergency medical transportation (NEMT) is available for a member with a medical and/or physical condition that makes transportation by ordinary public or private transportation medically contraindicated, [...]Read more