Updated Hospice Claims and Reimbursement Procedures

Updated Guidelines for Hospice Claims and Reimbursements Date: July 31, 2025 From: Health Plan of San Joaquin/Mountain Valley Health Plan ("Health Plan") To: Healthcare Providers Subject: New Policies on Hospice Claims Submission and Payment Procedures Business Area: Medi-Cal Managed Care Effective immediately, HPSJ/MVHP has revised its billing and claims processing procedures for hospice services in accordance with the latest directives from the Department of Health Care Services (DHCS), including All Plan Letter (APL) 25-008 and the Medi-Cal Provider Manual. Providers must adhere to these updated standards to guarantee accurate claim processing and prompt reimbursement. Provider Eligibility Criteria To qualify for payment, hospice providers must: - Hold a valid license issued by the California Department of Public Health (CDPH) - Be certified by Medicare - Be enrolled as Medi-Cal providers - Maintain credentials and have a contract with HPSJ/MVHP Documentation Requirements Hospice agencies are responsible for: - Submitting the Medi-Cal Hospice Program Election Notice and associated addendum to the health plan within five (5) calendar days of initiating hospice services for a m...