The Health Plan of San Mateo (HPSM) has noticed behavioral health providers underbilling claims and submitting subsequent requests for claims adjustments. To prevent this from happening in the future, providers are required to bill HPSM at the same rate as any other payer (UCR fees*). This will ensure your systems are ready for any rate changes in advance, eliminating the need for any retro changes or adjustments.
For context, HPSM’s behavioral health standard network rate is tied to the Medicare fee schedule, which is updated annually at the beginning of the calendar year. This schedule is subject to change throughout the year via regulatory notices by the Centers for Medicare & Medicaid Services (CMS).
Please direct questions to HPSM Provider Services at [email protected].
* Usual Customary and Reasonable (UCR) fees are used to establish a reasonable and customary rate for reimbursement from third-party payers in billing and insurance claims. These fees are usually based on the amount of money a health care provider would normally charge for a given service or procedure and can be more than the contractual obligations agreed to in the provider contract.