Health Plan of San Joaquin / Mountain Valley Health Plan

Provider Services for Health Plan of San Joaquin / Mountain Valley Health Plan Medi-Cal and Health Plan Advantage D-SNP (San Joaquin, Stanislaus, El Dorado, Alpine counties).

Automated eligibility verification for providers, listed for both Medi-Cal and D-SNP.

General fax listed in the provider contact block for both Medi-Cal and D-SNP. Not for prior authorizations, which have their own faxes.

Medi-Cal prior authorization request fax; requests may also be submitted online via the Doctors Referral Express (DRE) portal.

Advantage D-SNP prior authorization request fax (different from the Medi-Cal PA fax).

Inpatient admission notification/coordination line listed for both Medi-Cal and D-SNP providers.

Submit claims electronically (Trizetto, Office Ally, Waystar, SSI, Smart Data Solutions, FinThrive; payer ID HPSJ-MVHP) unless documentation is required; initial and corrected paper claims for Medi-Cal and Advantage D-SNP go to this address. Claim questions: Customer Service or your Provider Services representative.

Behavioral health care coordination/case management referrals for Health Plan members (outpatient BH needs no PA except TMS). Specialty mental health for serious conditions goes to the county ACCESS lines.

Member complaint/appeal forms (used for Advantage D-SNP and other Health Plan programs) can be faxed, emailed, mailed or filed online; providers helping a member file use the same route. Not for provider claim disputes.

Member customer service; TTY 711. Published as 1-888-936-PLAN (7526).

D-SNP member customer service; TTY 711. Published as 1-888-361-PLAN (7526).