Provider Alerts

REMINDER

The Health Plan of San Joaquin (HPSJ) website provides information about programs and services. You can view or download information about the following topics on the website:

• HPSJ’s Case Management program and the process to refer members to Case Management
  o HPSJ’s Disease Management program and the process to refer members to disease management.
  o Information about Enhanced Care Management (ECM) and how to request access to ECM.
  o Information about Community Supports offered by HPSJ, and how to request access.
  o Information about member Continuity of Care protections and how to initiate a request for Continuity of Care.
  o Information about how to request services requiring prior authorization.
• Information about HPSJ’s medical necessity criteria, including how to obtain or view a copy
• Information about the availability of staff to answer questions about Utilization Management (UM) issues
• The toll-free number to contact staff regarding UM issues
• Information about how members may obtain language assistance to discuss UM issues
• The availability of TTY/TDD 711 services for members
• Clinical Practice Guidelines
• Preventative Health Guidelines
• HPSJ’s policy prohibiting financial incentives for utilization management decision makers
• Information about HPSJ’s pharmaceutical management procedures
• A description of the process to review information submitted to support practitioner’s credentialing application, how to correct erroneous information and, upon request, how to be informed of the status of the credentialing or re-credentialing application.
• HPSJ’s member rights and responsibility statement
• Information regarding HPSJ Quality Management Program including performance metrics.
• UM decision making is based only on appropriateness of care, services, and existence of coverage.
• HPSJ does not specifically reward practitioners or other individuals for issuing denials of coverage.
• HPSJ’s Affirmative Statement Regarding (UM) Incentives

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 of San Joaquin and our services is always available on our website https://www.hpsj.com/