Providers
Prior Authorizations
Referrals
Prescription Authorization Requests
Specialty Provider Authorizations
PAR List Changes
Glucose Monitors
Claims
Submit Claims
Rebill, Correct or Update Claims
Submit a Claims Dispute or Appeal
Get Paid Faster with EFT/ERA
Contact Claims Services
Provider Resources
Provider Manual
Cultural Competency
Language Assistance Services
Care Coordination
Behavioral Health
Provider Incentive Programs
Section 1: About HPSM
Section 2: Customer Support
Section 3: Member Complaints
Section 4: Claims
Section 5: Provider Disputes
Section 6: Ancillary Services
Section 7: Utilization Management
Section 8: Provider Services
Section 9: Quality Improvement
Section 10: Health Education
Section 11: Fraud Waste and Abuse
Section 12: Privacy
Clinical Guidelines
Language Interpreter Services
Translated & Alternative Format Member Materials
Language Documentation Requirements
Language Training and Resources
Provider Forms
Directory Search
Formulary Search
Diabetes Prevention Program
End of Life Care
Grievance & Appeals Process
Healthcare Effectiveness Data and Information Set
Home Health Care
Initial Health Appointment
Maternal Care
Medical Record and Facility Site Reviews
Member Handbooks
HEALTHmatters MD
Pediatric Care
Potential Quality Issues
Urgent Care
Tobacco Cessation Information and Resources
Identifying Tobacco Users
Treating Patients Who Use Tobacco
Vulnerable Populations
Provider Education and Trainings
Older Adults and People with Disabilities
Provider Videos
Remote Patient Monitoring
Incentives for Primary Care Providers
Incentives for Nursing Facilities
Incentives for Specialty Providers
Learning Lab
SB855 Training Request
HPSM Dental Providers
Join HPSM Dental
Dental Provider Payments
Covered Dental Services
Benefits of Dental Integration
HPSM Dental Mission
An Innovative Pilot Program
Patient Experience
CalAIM at HPSM
Urgent Messages
News & Updates
Provider Portal / eReports
Join Our Provider Network
Provider Contacts
All Provider Tasks
Incentive Payments for Nursing Facilities
HPSM offers bonus payments for quality performance to in-network nursing facilities providing skilled and/or long-term care services to our Medi-Cal and CareAdvantage members. In-network facilities are automatically opted-in to the following upside-only bonuses:
- Nursing Facility P4P offers bonus payments based on performance in quality metrics designed to improve HPSM member bed access, reduce inpatient and emergency department utilization, and improve care transitions.
- Community Discharge P4P offers long-term care facilities bonus payments for successfully discharging HPSM members with extended institutional stays to a community setting where they remain continuously for six months or more.
Resources
- 2023 Nursing Facility P4P – These program guidelines contain comprehensive information on structure and quality performance metrics.
- 2023 Community Discharge P4P – This incentive overview provides information on the eligibility requirements for a credited discharge and community retention.