Providers
Prior Authorizations
HPSM Dental Providers
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
Care Coordination
Behavioral Health
Value Based Payment Program
Learning Lab
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 Assistance Services
Cultural Competency
Get a Phone or Video Interpreter
Get Translated Member Materials
Language Documentation Requirements
Health Literacy
Language Training & Resources
Provider Language Assistance Checklist
Tips for Supporting LGBTQIA+ Patients
Interpreter Services Request
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
Newsletters
Pediatric Care
Potential Quality Issues
Urgent Care
Tobacco Cessation Resources
Older Adults and People with Disabilities
Provider Videos
Remote Patient Monitoring
Join HPSM Dental
Dental Provider Payments
Covered Dental Services
Benefits of Dental Integration
HPSM Dental Mission
An Innovative Pilot Program
Urgent Messages
News & Updates
Provider Portal / eReports
CalAIM at HPSM
Join Our Provider Network
Provider Contacts
All Provider Tasks
Provider Services
Toll free: 1-833-694-7761 Local: 650-616-2106
Fax: 650-616-8046
Email: psinquiries@hpsm.org
Timeframes for filing & resolving complaints
Timeframes for filing a grievance or appeal:
- vary by line of business (i.e., CareAdvantage, Medi-Cal, HealthWorx HMO and ACE)
- are regulated by CMS and the State
CareAdvantage Cal MediConnect
Timeframe for filing
Complaints can be filed at any time.
Appeals must be filed within 60 days of the event.
Timeframe for processing
| Type | Appeals processing | Grievance processing |
| Part C - Standard | 30 calendar days | 30 calendar days |
| Part C - Expedited | 72 hours | 24 hours |
| Part D - Standard | 7 calendar days | 30 calendar days |
| Part D - Expedited | 72 hours | 24 hours |
Other lines of business
Timeframe for filing
from date of denial, service, incident or bill
| Type of complaint | Medi-Cal/CareAdvantage | Other lines of business |
| Appeal | 60 days | 180 days |
| Grievance | No time limit | 180 days |
Timeframe for processing
| Type | Grievance and appeals processing |
| Standard | 30 calendar days |
| Expedited | 72 hours |
If you have questions about the HPSM's Grievance and Appeals process, please contact HPSM Provider Services at 650-616-2106.