Prior Authorization for Referrals

An HPSM-contracted PCP can refer patients to:

  • HPSM-contracted specialists without prior authorization
  • Specialists outside of HPSM’s network if an appropriate in-network specialist is not available

To refer to a non-network specialist:

  • Identify and contact the specialist provider to assure that he or she will be able to see the member on a timely basis and make arrangements to follow up after the visit
  • Fill out part 1 of the Referral Authorization Form and fax it to HPSM at 650-829-2079
  • Do not send an unauthorized RAF to the specialist’s office
  • If HPSM approves your request, an authorized RAF will be faxed to the specialist’s office
  • Upon receipt, the specialist can contact the member to schedule an appointment

Referral Forms

Referral Authorization Fax Numbers

Out-patient referral:


Behavioral Health and Recovery Services referral:


CBAS and MSSP referral:


Care Coordination referral: