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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
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Provider Forms
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Diabetes Prevention Program
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Grievance & Appeals Process
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Older Adults and People with Disabilities
Provider Videos
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Incentives for Nursing Facilities
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HPSM Dental Providers
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Patient Experience
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
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.