Behavioral Healthcare Services – Claims and Disputes
| Date: | September 26, 2024 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) |
| To: | Health Plan Primary Care Providers, Specialists, Behavioral Health Providers, and Ancillary Providers |
| Type: | Regulatory |
| Subject: | Behavioral Healthcare Services – Claims and Disputes |
| Business: | Medi-Cal Managed Care |
As a reminder to all Health Plan providers, as of October 1, 2024, all behavioral healthcare services will be managed and coordinated by Health Plan. We are coordinating services with Carelon Behavioral Health for any members in care prior to that date. Any providers who were previously submitting claims and claims disputes to Carelon Behavioral Health should submit claims and claims disputes directly to Health Plan, starting October 1, 2024, regardless of date of service.
Please below for the instructions on how to submit claims and claims disputes. For additional reference, claims submission and dispute resolution details can be found in the Health Plan Provider Manual at https://www.hpsj.com/provider-manual/. Please note, there have been updates to our clearinghouses which are detailed below.
For Claims Submission:
| Paper Claims | Electronic and EDI Claims |
| Mail to:
Health Plan of San Joaquin/Mountain Valley Health Plan Paper Processing Facility P.O. Box 211395 Eagan, MN 55121 |
Providers must establish an account with a clearinghouse of choice. Health Plan currently uses the following clearinghouses:
Office Ally (Payer ID: HPSJ1) WayStar (Payer ID: HPSJ2) TriZetto/Cognizant (Payer ID: HPSJ)
Please contact the clearinghouse vendor of choice to set up electronic claim submission.
If you utilize a different clearinghouse that Health Plan does not already have, it will be set up once Health Plan is contacted by the clearinghouse.
For any questions or assistance, contact the Provider Services Department at 1-209-942-6340. |
For Provider Dispute Resolution Submission:
| Contracted Providers | Non-Contracted Providers |
| Submit a Provider dispute online through the Provider Portal/Doctors Referral Express (DRE) (Provider.hpsj.com/dre/default.aspx).
|
Mail in Provider disputes as indicated below with the appropriate Health Plan Provider Dispute Resolution (PDR) form located at www.hpsj-mvhp.org.
Attention to: Claims Department Health Plan of San Joaquin/Mountain Valley Health Plan P.O. Box 30490 Stockton, CA 95213-30490 |
For claims questions:
- Call Health Plan at 1-888-936-7526
For additional information about behavioral healthcare services, please visit our provider webpage: https://www.hpsj.com/providers/behavioral-health-services/
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
