Provider Alerts

The remittance advice (RA)/explanation of payment (EOP) details is now available starting today. All providers will now have the ability to access their payment details through the provider portal, Doctors Referral Express (DRE). If you are not already a DRE user, please sign up by completing the form found here: https://hpsj4.wpengine.com/wp-content/uploads/2019/03/DRE_Confidentiality_Statement_Form.pdf. Please fax the completed form to the Provider Services Department at (209) 461-2565.

If you are already a DRE user, no action is needed. You automatically have access to the Remittance Advice tool.

Below are instructions on how to navigate to the RA tool via DRE.

1. Click the Remittance Advice link on the left panel.
2. Select the appropriate filters to download your RA for your specific check program. At this time, the Check Run Programs available are Capitation and Fee-for-Service (FFS)

Prop 56 payment details, value-based payment details, and denial reason codes with descriptions are coming soon. We are continuing to develop the RA information and will notify you once this information is available. In the meantime, if you need to obtain the denial reasons for any claims, you can continue to obtain this information in the Search Claims link on the Toolbar.

We are committed to maintaining the following payment cadence via paper checks until we resume operations with Change Healthcare or other solutions are instituted:

• Capitation (monthly)
• FFS (twice per week)
• Proposition 56 (monthly)
• Value Based Payment (VBP) (monthly)

As a reminder, Change Healthcare is not currently available to receive claim submissions for Health Plan. The following option is available for mailed-in paper claim submissions:

Health Plan of San Joaquin/Mountain Valley Health Plan

Paper Processing Facility

P.O. Box 211395

Eagan, MN 55121

Health Plan also has two alternative clearing houses that you can enroll with to submit electronic claims, Office Ally and WayStar. Their contact information and links to instructions are below:

Office Ally
Payer ID: HPSJ1
866-575-4120
info@officeally.com
support@officeally.com
Office Ally Enrollment Resources:
Enrollments Department 360-975-7000 Option 3
enrollmentadmin@officeally.com
https://cms.officeally.com/Register/Register.aspx
https://player.vimeo.com/video/269695928

WayStar
Payer ID: HPSJ2
Main WayStar: 844-816-0524
Physician practices & other organizations: 844-392-9782
https://www.waystar.com/

We will continue to provide updates and make you aware of any changes. You may also visit Change Healthcare’s website for any updates at https://status.changehealthcare.com/incidents/hqpjz25fn3n7

We appreciate your understanding and patience during this time and apologize for any inconvenience this has caused.

If you are a non-contracted provider, you may contact Customer Service to request access to the Remittance Advice Details.

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