Updates

Provider Updates are published when we need to communicate any important health plan information to our Providers.

If you would like a printed copy of our most current issues or if you need assistance, please use our online Contact Us form.

VHP to Launch Epic in 2023

Data

Valley Health Plan (VHP) will be launching Epic Tapestry in March 2023, as a replacement to VHP’s current Valley Express referral/authorization/eligibility system.  One of the overarching goals is to improve the quality and efficiency of the interactions between VHP and our network providers.

As a VHP network provider, how does this benefit you? 

Through VHP Access, you will be able to:

  • Submit prior authorization requests
  • Verify health coverage and benefits information
  • Submit and view claims
  • Receive status notifications regarding claims and authorizations

VHP’s Provider Relations team has identified high utilizers of Valley Express and is conducting outreach to educate providers and their staff about the new VHP Access portal. 

Beginning in January 2023, VHP will offer live and virtual training sessions to providers, clinical staff and administrative professionals.                

VHP will share more information regarding the Epic Tapestry launch and training opportunities over the next few months.  If you have any questions, please contact VHP Provider Relations at 408-885-2221 or email:  [email protected].

 Every Visit is an Opportunity to Recommend the Flu Shot

Flu Vaccination

Now that flu season is here, it’s more important than ever to recommend the flu vaccine to your patients.  VHP is endorsing the *SHARE method as an effective way to communicate with patients about the flu shot during every encounter.

  • Share the reasons:  avoid getting sick, hospitalization and even death from the flu virus (for some)
  • Highlight positive experiences:  spending time with friends and family, enjoying your favorite hobbies, feeling healthier
  • Address patient questions:  Is the flu shot safe?  Can I get the flu shot at the same time as my COVID-19 booster?
  • Remind patients that flu shots help protect them and their loved ones:  especially older adults, children and those with health issues
  • Explain the potential costs of getting influenza:  getting ill for 1-2 weeks, missing work and activities

    *SHARE method – Centers for Disease Control and Prevention (CDC)

Thank you in advance for sharing this information with your patients.

Behavioral Health Update – Effective January 1, 2022

Outpatient visits with VHP in-network contracted psychiatrists do not require prior authorization as of January 1, 2022. Please note: Stanford and LPCH require prior authorization as out-of-network quaternary providers. 

Provider Update - Effective September 2021

AAAHC Accreditation Survey

Valley Health Plan (VHP) will be undergoing a re-accreditation survey by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) on October 26-28th, 2021 for all Commercial Lines of Business. This survey is conducted on a three-year cycle to ensure the health plan continues to provide quality services to its members in alignment with AAAHC's national standards of care. All interested individuals holding pertinent and valid information about the organization’s compliance with AAAHC standards may request a presentation with AAAHC surveyors or may communicate such information in writing or by telephone to AAAHC for consideration. Any additional information can also be provided and discussed with the Valley Health Plan Accreditation Director, Carley Flores at [email protected]

Public Notice Posting - AAAHC Re-Accreditation Survey 2021

Acupuncture/Chiropractic Benefits Update – Effective 8/1/21

Click here for more information

MY2020 Provider Survey Results - Issued April 15, 2020

Below are links to the following 2020 Provider and Practitioner Survey Reports:

MY2020 Provider Satisfaction Summary Report

MY2020 Practitioner After-Hours Summary Report

MY2020 Provider Appointment and Availability Summary Report

CAHPS/QHP Progress

Valley Health Plan contracted with SPH Analytics an NCQA certified vendor to field the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for Commercial and Qualified Health Plan (QHP) survey for Exchange plans. 

Click here for more information

How to Bill for Blood Lead Screening Given to Medi-Cal Recipients

Information on when to perform periodic health assessments on children and how to bill for Blood Lead Screening

Click here for more information

COVID-19 Vaccine Update for VHP's Covered California, Individual & Family Plans, and Commercial Employer Group

This Provider Update includes important information about the rapidly evolving news regarding the COVID-19 vaccines’ availability, the individuals prioritized in each phase to receive it, and the steps VHP is taking to help you process vaccine-related reimbursement claims.​

Click here for more information​

How the Quality Management (QM) Team is Working for You

The Quality Management program is centered on Valley Health Plan’s (VHP) vision and mission. The scope and content of the quality program represent the entire VHP delivery system. The team’s monitoring and evaluation activities involve a planned, systematic, and ongoing process to improve the quality of care, and service members receive.​

Click here for more information​

Non-Contracted Provider Reimbursement Policy

Commencing October 1, 2021, non-contracted provider claims are paid in accordance with VHP's Non-Contracted Provider Reimbursement Policy set forth below. Click below for more policy and regulation information. 

Provider Reimbursement Policies and Procedures Operating Manual 2022

 

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