December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Newborn Gateway- Reminder on How to Inform Families Business: Medi-Cal Managed Care As recently communicated by Health Plan, effective July 1, 2024, Assembly Bill 118, Chapter 42, Statutes of 2023, requires [...]
Read more
Health Plan of San Joaquin provider Alerts
Provider Manual Update 45 Day Notice
January 2, 2025 / by Health Plan / Alerts
Date: January 02, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Health Plan Providers and Facilities Type: Regulatory Subject: Provider Manual Update 45 Day Notice Business: Medi-Cal Managed Care The following information serves as an official 45-business day notice regarding updates to the Provider Manual. Health Plan of San Joaquin/Mountain [...]Read more
Medical Benefit Update
January 2, 2025 / by Health Plan / Alerts
Date: January 02, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Pharmacy and Theraputics Committee To: Health Plan Providers and Practitioners Type: Formulary Subject: Medical Benefit Update Business: Medi-Cal Managed Care Effective March 10, 2025 the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit. Code J1632 [...]Read more
Calendar Year (CY) 2024 Medi-Cal Targeted Rate Increases (TRI) and Impact to Proposition 56 Directed Payments
December 30, 2024 / by Health Plan / Alerts
Date: December 30, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) To: Behavioral Health Providers Previously Contracted with Carelon Type: Regulatory Subject: Calendar Year (CY) 2024 Medi-Cal Targeted Rate Increases (TRI) and Impact to Proposition 56 Directed Payments Business: Medi-Cal Managed Care Pursuant to the 2023 Budget Act and Assembly Bill [...]Read more
Enhanced Care Management Presumptive Authorization – Live as of 01/01/2025
December 30, 2024 / by Health Plan / Alerts
Date: December 30, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Enhanced Care Management (ECM) Providers Type: Informational Subject: Enhanced Care Management Presumptive Authorization – Live as of 01/01/2025 Business: Medi-Cal Managed Care Presumptive authorization enables the Enhanced Care Management (ECM) Provider to deliver ECM for a 30-calendar [...]Read more
Updates – DHCS APL 24-009 (Skilled Nursing Facilities), APL 24-010 (Subacute Care Facilities), APL 24-011 (Intermediate Care Facilities)
December 27, 2024 / by Health Plan / Alerts
Date: December 26, 2024 From: Health Plan To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Facilities Type: Regulatory Subject: Updates - DHCS APL 24-009 (Skilled Nursing Facilities), APL 24-010 (Subacute Care Facilities), APL 24-011 (Intermediate Care Facilities) Business: Medi-Cal Managed Care On September 16, 2024, the Department of Health Care Services (DHCS) [...]Read more
Medicare Dual Special Needs Plan (D-SNP)
December 18, 2024 / by Health Plan / Alerts
Date: December 18, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers Type: Regulatory Subject: Medicare Dual Special Needs Plan (D-SNP) Business: Medi-Cal Managed Care Starting January 1, 2026 and subject to regulatory approval, Health Plan will be offering a Medicare Dual Special Needs Plan (D-SNP). D-SNPs are [...]Read more
Update – Calendar Year (CY) 2024 Medi-Cal Targeted Rate Increases (TRI) and Changes to PCP Capitation Rates
December 16, 2024 / by Health Plan / Alerts
Date: December 12, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Primary Care Providers and Capitation Payments Type: Regulatory Subject: Update - Calendar Year (CY) 2024 Medi-Cal Targeted Rate Increases (TRI) and Changes to PCP Capitation Rates Business: Medi-Cal Managed Care Health Plan recently communicated about the Medi-Cal [...]Read more
How to refer for Behavioral Health Services and Case Management
December 16, 2024 / by Health Plan / Alerts
Date: December 11, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Practitioners and Facilities Type: Informational/Educational Subject: How to refer for Behavioral Health Services and Case Management Business: Medi-Cal Managed Care The Department of Health Care Services (DHCS) issued All Plan Letter 22-005 (APL-22-005) “No Wrong Door for [...]Read more
Medi-Cal Pharmacy (Rx) Update – Pediatric Integration
December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Practitioners and Facilities Type: Informational/Educational Subject: Medi-Cal Pharmacy (Rx) Update – Pediatric Integration Business: Medi-Cal Managed Care EFFECTIVE JANUARY 31, 2025, Medi-Cal Rx will reinstate claim edits and prior authorization (PA) requirements for members 21 years of [...]Read more
Newborn Gateway- Reminder on How to Inform Families
December 4, 2024 / by Health Plan / Alerts
Date: December 4, 2024 From: Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) To: Health Plan Providers and Practitioners Type: Regulatory Subject: Newborn Gateway- Reminder on How to Inform Families Business: Medi-Cal Managed Care As recently communicated by Health Plan, effective July 1, 2024, Assembly Bill 118, Chapter 42, Statutes of 2023, requires [...]Read more