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Yes, all patients in a SNF who transition to HPSJ will need an authorization issued by HPSJ.

DHCS provided HPSJ with data that includes HPSJ members who are receiving LTC services. HPSJ will proactively contact each nursing facility to validate the information. Upon working with the facility to verify the information from DHCS, HPSJ will issue new authorizations for HPSJ members in your care.

Nursing facilities are required to follow HPSJ’s standard authorization procedures for HPSJ members who are not included in the SNF data provided by DHCS.

Authorization requests must be submitted electronically through Doctor’s Referral Express, HPSJ’s the provider portal. Visit www.hpsj.com/providers to login or create a new account. You may also submit an authorization request by secure fax to (209) 762-4702. If submitted by fax, include the current authorization request form. Supporting clinical documentation must be included for electronic or faxed authorization requests.

HPSJ will contact you to provide the list of HPSJ members receiving care from your facility. Be prepared to review the list as soon as you receive it:

1. Ensure that all LTC patients transitioning to HPSJ are on the list.
2. If someone on the list is no longer a resident, please indicate the date of discharge.
3. If a resident is not on the list, submit an authorization request for that member to HPSJ.

HPSJ will receive TAR data from DHCS and will contact the affected facilities to verify and arrange for any new authorizations.

Whenever an HPSJ member is transferred/discharged from the facility, you must notify HPSJ of the transition. For transfers to the acute hospital, submit a request for authorization of a bed hold online using Doctor’s Referral Express, www.hpsj.com/providers or by sending the authorization request form by fax to (209) 762-4702.

The facility will receive fax notification of the authorization information.

When requesting re-authorization, include the most current provider progress note validating the need for continued stay, as well as the MDS for your HPSJ patient.

Re-authorization can be requested 2-4 weeks prior to the current authorization expiration date.

A list of HPSJ contracted providers can be found using HPSJ’s provider search tool located at: www.hpsj.com/find-a-provider Pharmacy benefits are administrated by DHCS through Medi-Cal RX and can be found on the Medi-Cal RX website: www.medi-calrx.dhcs.ca.gov/home. View tools and resource section.

Under skilled stay, Medicare B members will require auth for room & board. When transitioning to LTC, all members will require authorization.

No

Yes, claims can be billed on a bi-weekly basis.

Contact Office Ally to confirm that they can process your LTC claims for HPSJ Members.

Change HealthCare (CHC) is HPSJ’s contracted payment vendor. Claim payments are dispersed according to your current set up with CHC.

Non-covered services (NCS) items must be billed separately.

Yes, SNF’s should bill LTC services using a ub04 claim form.

Physical therapy services are reimbursed as part of the supplemental payment for the first 45 days of admission. After 45 days, authorization must be obtained for additional physical therapy services, and those services must be billed separately.

We do not differentiate between the two when it comes to billing. Providers should bill the same revenue codes for all levels of care. Here are the revenue codes you should use:

• 0101 = All Inclusive Room and Board (bill in conjunction with accommodation code 01)
• 0180 = Leave of Absence – General (bill in conjunction with accommodation code 02 or 03)
• 0185 = Bed Hold (bill in conjunction with accommodation code 73)