Our Vision:


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Recent News: UPDATED 07/19//2018
  1. To ensure that a heath care delivery system is in place, which provides available, accessible and adequate numbers of facilities, locations, and personnel for the provision of health care services.
  2. To ensure that a health plan members are provided covered services without regard to race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual preference or physical or mental handicap.
  3. To ensure that the SJIPA has in place the organizational and administrative systems capable of messaging medical services contracts between providers and third party vendors
  4. To ensure that the quality of care to all patients continues at the highest level of  care possible.  
  5. Provide support for community health education and wellness.


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ALERT

All Molina Contracted providers: Lab Issue


To all Molina providers who have been affected by the lab issue:  Molina has reported that they will not be reprocessing the lab charges that were denied due to their change of policy (see Provider News Bulletin, corrected version, February 6 2018).   San Juan IPA has notified Molina that we see this as a breach of contract issue, and as a result of this and other issues with the payer the IPA has seen member terminations. 

           

Though we do see this as a breach of contract issue, we also recognize that it only affects a small number of our member practices and therefore we are not issuing a network termination.  At this time Molina has not been successful in their Centennial Care 2.0 appeal (though I believe it’s ongoing) and they have a very small footprint with the Marketplace product.  We have opted to hold on any action into 2019 and wait to see what will happen with the payer in this market.  It may very well be that the issue is self-correcting.


Please contact the IPA with any questions about this matter.  Thank you.


Casey Crotty

Chief Executive Officer

San Juan IPA and Affiliates


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The San Juan IPA was founded in 1986 by a group of 21 community physicians to partner with

insurance companies with the goal of improving the quality of care to patients while simultaneously

decreasing the cost of care to those payers. Originally formed with a “Quality Assurance Committee”,

the San Juan IPA has grown to over 450 members representing 39 specialties and sub-specialties

in 70+ offices across New Mexico, a HEDIS quality review function, a Credentialing Committee,

and a care management committee component.


As an NCQA-accredited organization, San Juan IPA’s core services of contracting and

credentialing are complemented by an array of expanding resources for the physician office,

helping keep practice costs low and quality of care high.  We continually look for ways to

promote new quality initiatives both within and outside the practice walls for patients and employers.