Covered Services
San Mateo ACE Providers and Rules on Covered Services
San Mateo ACE Provider Network
The San Mateo Medical Center (SMMC) hospital and its primary care clinics, along with the Ravenswood clinics, and their linked
pharmacies comprise the San Mateo ACE provider network. These providers are located in Daly City, East Palo Alto, Half Moon Bay,
Menlo Park, Redwood City, San Mateo, and South San Francisco.
San Mateo Medical Center is the only San Mateo ACE hospital.
Click here for a full listing of the
San Mateo ACE Provider Network
Referral and Prior Authorization Requirements for Non-ACE Providers
- Services provided to San Mateo ACE patients by non-ACE community providers are only covered if they are referred by a
San Mateo ACE provider and approved by HPSM. Referrals are generally limited to a small group of providers who have service
contracts with HPSM.
- Prior authorization requirements for medical necessity review may also apply.
- Out-of-county services also require referral and/or prior authorization from HPSM.
- San Mateo ACE participants are financially responsible for services provided without authorization from HPSM.
Click here to access authorization and referral forms
Other Coverage Rules
- Eligibility verification. Services are only covered for eligible participants whose
eligibility is active on the date of service.
- Emergency care. Emergency care is covered only at San Mateo Medical Center.
Claims for emergency services received at other hospitals will be denied. Hospitals are responsible for covering
emergency care to San Mateo ACE participants under their charity care and SB 12 requirements.
- Repatriation of San Mateo ACE participants. SMMC will accept emergency care
patients from other hospitals who have been stabilized. Coordination with the SMMC medical management team is
required. To repatriate a San Mateo ACE Participant, please contact SMMC’s Admitting Clerk at 650-573-2657.