An HPSM-contracted PCP can refer patients to:

  • HPSM-contracted specialists without prior authorization using your office's referral process (for ACE members, please use the ACE referral authorization form)
  • Specialists outside of HPSM’s network if an appropriate in-network specialist is not available
  • Dental referrals can be made by using our dental referral form or by calling 650-616-1522

To refer to a non-network specialist:

  • Identify and make a referral to the specialist using your own office's referral process. 
  • The non-network specialist must then submit a prior authorization form for any services rendered, including regular office visits. The prior authorization request will be reviewed by HPSM and the decision will be communicated to the out-of-network specialist. Click here for review response times. 
  • Upon authorization, the specialist can move forward with providing care to the member.

Referral Forms

Referral Authorization Fax Numbers

Out-patient referral:


Behavioral Health and Recovery Services referral:


CBAS and MSSP referral:


Care Coordination referral: