Provider Manual

Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) is pleased to have you as part of our provider network. We recognize that the strength of our health care programs depends upon strong collaboration and communication with our providers, practitioners and their staff.   The Provider Manual is intended to be a useful guide for participating providers/practitioners with Health Plan.

For the purposes of the Provider Manual, “provider” refers to health care practitioners and providers including any physician, nurse, other health care practitioner, hospital, ancillary provider, or other person or institution that furnishes Covered Services.

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If you would like to download each section on its own, please click on the “PDF Download” button.

  • Section 1: Introduction
  • Section 2: Benefit Program
  • Section 3: Provider Credentialing
  • Section 4: Provider Contracting
  • Section 5: Provider Services
  • Section 6: Eligibility, Enrollment, and Disenrollment
  • Section 7: Provider–Member Relationship
  • Section 8: Utilization Management
  • Section 9: Care Coordination
  • Section 10: Claims Submission
  • Section 11: Provider Payments
  • Section 12: Dispute Resolution
  • Section 13: Quality Improvement and Health Equity (QIHE)
  • Section 14: Pharmacy Services
  • Section 15: Behavioral Health
  • Section 16: Regulatory Compliance
  • Posted on October 3rd, 2016 and last modified on August 13th, 2024.

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