Prior Authorizations

Before providing treatment or prescribing medication for an HPSM member, you may need to submit a Prior Authorization Request Form to ensure that it is covered. HPSM expects providers to obtain authorization for all services requiring prior authorization before they provide the service. Exceptions are made for urgent and emergency services.

 

Please make sure your form meets the following requirements – failure to do so will result in a rejected request:

  1. Use the current form (version 3.2 September 2020).
  2. Use the fillable form (typed, not hand-written).
  3. Only select “Urgent” if it’s truly an urgent matter. Most requests will be “Routine” requests.
  4. Do not check the “LTC” box unless you are truly a long-term care provider or facility.

For authorization requests submitted prior to the date of service, expect a response from HPSM:

  • 72 hours for urgent (a delay in care could seriously jeopardize the life or health of the patient or the patient's ability to regain maximum function and/or a delay in care would subject the member to severe pain that cannot be adequately managed without the care or treatment requested in the prior authorization).
  • 5 business days for routine (all other requests).

 

Current Authorization List

Before submitting a request, search HPSM's Prior Authorization List by CPT code or service name to see if you need to get prior authorization: View online | Download

HPSM regularly updates our list of codes requiring prior authorization to reflect current clinical guidelines. You can review these changes or archived lists on the PAR List Changes page.

Read our latest provider notification on the new code changes here: Q2 Prior Authorization and Covered Services Changes Effective 6/1/2021

 

Frequently Asked Questions

The servicing Provider should submit the prior authorization.

We do accept retro requests that are under a year old, but remember prior authorization is supposed to be obtained before a service is rendered. For example, a service rendered on 6/10/2022 would have until 6/9/2023 to submit.

Please check your fax machine. If you have not received your letter within two days after our turnaround times, please contact the Prior Authorization Department at 650-616-2070 and one will be faxed to you.

Facesheets should be faxed to 650-829-2060.

Prior Authorizations 101