Submit a Claims Dispute or Appeal
HPSM network provider disputes
Providers have the right to dispute claims that HPSM has denied, adjusted or potentially underpaid.
- To dispute individual claims, complete the Provider Dispute Resolution Request Form
- To dispute a bundled group of substantially similar claims, complete the Provider Dispute Resolution Supplemental Form
- To dispute HPSM’s requests for reimbursement of over payment on claims, fill out one of the above forms (depending on whether it concerns an individual claim or bundled claims).
After filling out the appropriate form, print and fax it to 650-829-2051.
Non-contracted provider disputes
CareAdvantage disputes must be submitted within 60 calendar days from the date of receiving notification (Remittance Advice) of HPSM’s claim action. Providers must sign and submit a Waiver of Liability verifying that they relinquish the right to collect payment from the member in order for HPSM to process the dispute.
If a waiver is not submitted, HPSM is required to send the dispute to the Medicare-contracted Independent Review Entity (IRE), which will issue the final dispute decision.