Provider Manual

This manual contains policies and procedures relevant to providers that are contracted with HPSM. It is designed as a reference tool to assist you with the administrative tasks related to accessing and providing comprehensive, effective, and quality medical services to HPSM members.

Please be aware that different policies and procedures may apply depending on the program(s) with which you are contracted. Also note that existing provider contracts may supersede some policies stated in this material.

Section 1 - Who to Call (190 KB)

Section 2 - Member Services (541 KB)

Section 3 - Member Complaints (465 KB)

Section 4 - Claims (592 KB)

Section 5 - Provider Disputes (151 KB)

Section 6 - Ancillary Services (392 KB)

Section 7 - Utilization Management (720 KB)

Section 8 - Provider Services (160 KB)

Section 9 - Quality Improvement (149 KB)

Section 10 - Health Education (98 KB)

Section 11 - Fraud Waste and Abuse (67 KB)

Section 12 - Privacy (77 KB)

Provider Manual Updates

This manual will be updated regularly as policies, programs and procedures change. Updates and supplements will be distributed as they occur and will be available as downloadable documents from this webpage for your convenience.

Please be sure to replace the existing pages in the manual upon receipt of any updates. This will assure that the manual you have available is the most current.

Comments and Suggestions

We welcome your feedback regarding this manual and hope that you will offer any suggestions on how we can improve either subject matter or layout. HPSM's goal is to make this manual as helpful and easy to use as possible. Please call the Provider Services Department at 650-616-2106 if you have suggestions or comments.