Providers
Prior Authorizations
Submitting Prior Authorization Requests
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
Refund Instructions
Contact Claims Services
Provider Resources
Provider Manual
Care Coordination
Behavioral Health
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
Cultural Competency
Language Assistance Services
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
Pediatric Care
Potential Quality Issues
Urgent Care
Tobacco Cessation Information and Resources
Identifying Tobacco Users
Treating Patients Who Use Tobacco
Provider Education and Trainings
Vulnerable Populations
Older Adults and People with Disabilities
Provider Videos
Remote Patient Monitoring
Mental Health and Substance Use Treatment
Behavioral Health Treatment/Applied Behavioral Health Analysis
Provider Incentive Programs
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
HPSM Provider News
Provider Portal / eReports
Join Our Provider Network
Provider Contacts
All Provider Tasks
Incentives 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 Pay-for-Performance ("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 Pay-for-Performance ("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.
- Skilled Nursing Facility Workforce Quality Incentive Program (SNF WQIP) is a Department of Health Care Services initiative that provides bonus payments to eligible SNFs that improve workforce stability and quality of care for Medi-Cal members.