Prior Authorization
For some types of care, your primary care provider (PCP) or specialist will need to ask HPSM for permission before you get the care. This is called asking for prior authorization, prior approval or pre-approval. It means that HPSM must make sure that the care is medically necessary or needed.
Care is medically necessary if it is reasonable and necessary to protect your life, keeps you from becoming seriously ill or disabled, or alleviates severe pain.
IMPORTANT NOTE: Prior authorization is based on medical necessity and not a guarantee of coverage or eligibility. If a service is not included on the list below, the service does not require prior authorization. However, this does not mean it is a covered benefit. Please talk with your provider to find out if a service is a covered benefit or call Member Services.
CareAdvantage members
Call 1-866-880-0606 or 650-616-2174 Monday–Sunday 8:00 a.m. to 8:00 p.m.
TTY: 1-800-735-2929 or dial 7-1-1
Email: CustomerSupport@HPSM.org
Medi-Cal and HealthWorx members and ACE Program participants
Call 1-800-750-4776 or 650-616-2133 Monday–Friday 8:00 a.m. to 6:00 p.m.
TTY: 1-800-735-2929 or dial 7-1-1
Email: CustomerSupport@HPSM.org