Financial Reporting and Accounting
What kind of an entity are we?
We are a local Medi-Cal managed care plan to meet the unique needs in San Joaquin and Stanislaus County.
What does FQHC stand for?
Federally Qualified Health Clinic
What month is the budget finalized in?
June
This process involves obtaining goods or services from an external source, often via a competitive bidding process.
What is procurement?
Who owns us?
Nobody. Health Plan of San Joaquin is governed by an 11-member Health Commission appointed by the San Joaquin County (SJC) Board of Supervisors. It’s comprised of two SJC Supervisors, a County Administration Officer, the SJC Director of Health Care Services, Hospital Council representative, community physicians and local representatives.
What does the “K” procedure type stand for on the Medi-Cal Fee Schedule?
Primary Surgeon
What does RDT stand for?
Rate Development Template
This document is sent to vendors to solicit bids for products or services, detailing the requirements and criteria for selection and seeking detailed solutions.
What is a Request for Proposal (RFP)?
What is the full form of DSNP?
Dual-eligible Special Needs Plan. (IE Medicare and Medicaid members.) DSNPs are specialized Medicare Advantage plans that provide healthcare benefits for beneficiaries that have both Medicare and Medicaid coverage.
What additional information is needed when a Physician Administered Drug is billed for proper pricing and encounter submission?
a valid National Drug Code (NDC)
What is the fiscal year for HPSJ/MVHP?
July to June
This document outlines the terms and conditions agreed upon between a buyer and a seller for the purchase of goods or services.
What is a contract?
Which year did we come into existence?
1996
What are the 3 digits that represent different items in the Bill Type of UB04 claims?
First Digit - indicates Type of Facility, Second Digit - indicates Bill Classification, Third Digit - indicates Frequency
How many COAs (category of aid) are there?
8
Contracts that require approval for values $200k+
What is F&I/Health Commission?
What is the reinvestment amount that has been advertised on our website?
$100 Million over 3 years with MVHP – Mountain Valley Health Plan
What are the four requirements to process a NEMT claim for payment?
1. authorization; 2. pick-up/drop-off location; 3. start/stop times of trip; 4. referring/ordering/prescribing physician
What category of service has the most expense?
Inpatient
This legal agreement outlines the responsibilities and expectations of both parties in a supplier relationship.
What is a service level agreement (SLA)?