Submit Claims

There are two methods HPSM providers can use to submit claims:

  1. Paper claims submission
  2. Electronic claims submission

Paper Claims Submission

Medical Providers

Dental Providers

Paper claims must be submitted on a CMS-1500 or UB-04 claims form and mailed to HPSM at:

The Health Plan of San Mateo
Attn: Claims Processing
801 Gateway Boulevard, Suite 100
South San Francisco, California 94080

To be eligible for payment, all paper claims must be filed on fully and accurately completed ADA or Medi-Cal dental claim forms with the current CDT procedure codes. Please note; if using the ADA dental claim form, please use the most recent 2019 version. Claims may be suspended or denied when data items on claim forms are incomplete or incorrect.

Please mail dental claims to:

HPSM Dental
PO Box 1798
San Leandro, California 94577

Electronic Claims Submission

Medical Providers

Dental Providers

Using standard EDI 837 format

  • Set up your user ID and password by calling Provider Services at 650-616-2106
  • FTP (File Transfer Protocol) to using dial-in number 650-616-8062
  • Plaintext only, migrating to 128-bit SSL encryption

Clearinghouse/Payer ID

  • Change Healthcare (formerly Emdeon and Capario)
    • For 837 Professional: SX174   
    • For 837 Institutional: 12X74
  • Office Ally: HPSM1
  • WayStar: HPSM1

Only CMS-1500 claims can be submitted through our Provider Portal at this time.

Claims Submission Instructions

Dental providers can submit electronic dental claims through their existing system/clearinghouse with the following information:


Payer Name: Health Plan of San Mateo Dental


To get set up with a clearinghouse please contact the Provider Services department at 650-616-2106 or


Question about a claim?

For information about a dental or medical claim, call 650-616-2106 or email

Email confirmation sent by next business day.

Business hours are Monday, Tuesday, Thursday and Friday – 8:00 a.m. to 5:00 p.m. (closed 12:00 p.m. to 1:00 p.m.)

Wednesday – 8:00 a.m. to 12:00 p.m.

Member eligibility

To check a member’s PCP assignment, and verify eligibility, providers should call HPSM’s 24-hour Automated Eligibility Verification System (AEVS) at 1-800-696-4776 and follow the automated instructions.

Member eligibility can also be checked via HPSM’s Provider Portal once a User ID and Password have been established. Please call 650-616-2106 for assistance.