AGING: HPSJ Missing Checks

CHECK TRACERS

If payment has not been received within thirty (30) days of the check issuance date, please contact the Provider Services Department at (209) 942-6340 or via email to Providerservices@HPSJ.com to initiate a check tracer. Provider Services staff will coordinate with the Health Plan’s Finance.

The department will investigate further to verify the status of the check payment. If the check has been cashed or deposited, a copy of the canceled check will be provided. If the check has not been cashed or deposited, an affidavit form must be completed and returned to the Provider Services Department via email to Providerservices@HPSJ.com or faxed to (209) 461-2565 to request reissuance of payment. Affidavits must be notarized for payments greater than $1,000.

Upon receipt of the completed affidavit, a stop payment order will be placed on the original check, and the Health Plan’s Finance Department will process the reissued payment on the next scheduled payment date.

PAYMENT DELAYS RELATED TO PROVIDER DIRECTORY

Under Section 1367.27 of the Health and Safety Code, Health Plan may delay payments if a Provider does not respond to attempts to verify information about the Provider published in the Provider Directory. Health Plan will not delay payment unless it has attempted to first verify the f

ENCOUNTER DATA SUBMISSION

PCP’s receiving capitation payments are required under the terms of their agreement/contracts to submit encounter data to Health Plan monthly. The monthly encounter data is essential information used by Health Plan, CMS, and DMHC/DHCS to accurately report and assess patient care and potential additional needs. The data can be submitted easily by using a CMS1500 claim form and may be submitted electronically. The encounter data must be received by HPSJ no later than the fifteenth (15th) of the month following the date services are rendered.

COORDINATION OF BENEFITS (COB)

When Health Plan is the secondary payer, all claims must be submitted within three hundred and sixty- five (365) days from the date of payment on the primary payer’s Explanation of Benefits(EOB) form. A copy of the EOB must be attached to the claim if submitted via paper. COB data canal so be submitted electronically if the claim is filed electronically. Medicare Part A and B claims are submitted directly to Health Plan from CMS electronically monthly. If the Member’s primary plan denies services and requests additional information, the information must be submitted to the primary insurance carrier before submitting to Health Plan.

Updated on 10/17/2024..DP