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.

 

Provider Update 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

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Free Webinar Training Opportunity on 5/21/21-CQC Resilient Primary Care Webinar

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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. 

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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

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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.​

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An Advance Copy of the VHP 2021 Provider Manual is Now Available for Preview

A new Valley Health Plan (VHP) Provider Manual for the Classic and Preferred Commercial Employer Group Plans, the Covered California Plan, and the Individual & Family Plan will be going into effect on February 1, 2021. As a contracted provider, you are the reason our members receive high-quality care. So, VHP is excited to offer you this sneak peek of the Provider Manual to review before its effective date. We hope you enjoy the new look and find it a helpful resource for your work with VHP and our members.

(NOTE: Providers contracted to serve VHP’s Medi-Cal participants, please continue to reference VHP’s 2020 Provider Manual. We will be issuing a new Medi-Cal Provider Manual in early 2021.)​ ​

Provider Manual 2021​

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 represents 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.​

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Non-Contracted Provider Reimbursement Policy

For dates of services commencing October 1, 2020, non-contracted provider claims will be paid in accordance with VHP's Non-Contracted Provider Reimbursement Policy set forth below. Click below for more policy and regulation information for the period October 1, 2020, through September 30, 2021.

Provider Reimbursement Policies and Procedures Operating Manual 2020

For dates of services commencing October 1, 2021, non-contracted provider claims will be 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 2021

Coronavirus (COVID-19) Guidance

Coding Guidelines

Effective Monday, July 6th, 2020 Valley Health Plan (VHP) will be implementing a code editing software that automates claims review and adjudication in accordance with current industry standard coding guidelines.

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