Provider Resources Claims Pharmacy Authorizations Language Assistance Provider Directories Forms NPI Update Clinical Guidelines Medi-Cal P4P Care Coordination End of Life Resources San Mateo ACE General Information ACE Covered Services ACE Submitting Claims Quality Programs Advisory Committees HEDIS CMS Initiatives Provider Portal Provider Newsletter Provider Services Provider News Provider Updates

Authorizations

Prior authorization requests for some covered services may be required for reimbursement.
Call HPSM Health Services for more information: 650-616-2070.

Types of Authorizations

There are three types of authorization used by HPSM.
Requirements may vary by program.

Online Resources

All types of authorization forms are available on our Forms Page

Updates

Referral authorization for services from non-contracted providers is required for these programs:

CareAdvantage TAR

CareAdvantage prior authorization TARs apply to:

Physicians use: CareAdvantage Outpatient Authorization Request Form
Facilities use: CareAdvantage Inpatient Authorization Request Form

CareAdvantage pharmacy authorization may be required for formulary drugs.

Guidelines and Tips

HPSM requirements regarding prior authorization for medical and pharmacy services.

• Prior Authorization Guidelines
• HPSM TAR Required List
• CPT Code Modifier List