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.
ACE Referral Authorization Form (384 KB)
Behavioral Health Referral Form (247 KB)
CBAS and MSSP Referral Form (93 KB)
Dental Referral Form (391 KB)
HomeAdvantage Member Referral Form (177 KB)
Palliative Care Referral: Adult (114 KB)
Referral Authorization Fax Numbers
Behavioral Health and Recovery Services referral:
CBAS and MSSP referral:
Care Coordination referral: