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