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Section 1: About HPSM
Section 2: Customer Support
Section 3: Member Complaints
Section 4: Claims
Section 5: Provider Disputes
Section 6: Ancillary Services
Section 7: Utilization Management
Section 8: Provider Services
Section 9: Quality Improvement
Section 10: Health Education
Section 11: Fraud Waste and Abuse
Section 12: Privacy
Clinical Guidelines
Language Interpreter Services
Translated & Alternative Format Member Materials
Language Documentation Requirements
Language Training and Resources
Provider Forms
Directory Search
Formulary Search
Diabetes Prevention Program
End of Life Care
Grievance & Appeals Process
Healthcare Effectiveness Data and Information Set
Home Health Care
Initial Health Appointment
Maternal Care
Medical Record and Facility Site Reviews
Member Handbooks
HEALTHmatters MD
Pediatric Care
Potential Quality Issues
Urgent Care
Tobacco Cessation Information and Resources
Identifying Tobacco Users
Treating Patients Who Use Tobacco
Vulnerable Populations
Provider Education and Trainings
Older Adults and People with Disabilities
Provider Videos
Remote Patient Monitoring
Incentive Payments for Primary Care Providers
Incentive Payments for Nursing Facilities
Incentive Payments for Specialists
Learning Lab
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HPSM Dental Providers
Join HPSM Dental
Dental Provider Payments
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Benefits of Dental Integration
HPSM Dental Mission
An Innovative Pilot Program
Patient Experience
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Urgent Messages
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Provider Portal / eReports
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Provider Contacts
All Provider Tasks
Provider Services
Toll free: 1-833-694-7761 Local: 650-616-2106
Fax: 650-616-8046
Email: psinquiries@hpsm.org
Timeframes for filing & resolving complaints
Timeframes for filing a grievance or appeal:
- vary by line of business (i.e., CareAdvantage, Medi-Cal, HealthWorx HMO and ACE)
- are regulated by CMS and the State
CareAdvantage
Timeframe for filing
Complaints can be filed at any time.
Appeals must be filed within 60 days of the event.
Timeframe for processing
| Type | Appeals processing | Grievance processing |
| Part C - Standard | 30 calendar days | 30 calendar days |
| Part C - Expedited | 72 hours | 24 hours |
| Part D - Standard | 7 calendar days | 30 calendar days |
| Part D - Expedited | 72 hours | 24 hours |
Other lines of business
Timeframe for filing
from date of denial, service, incident or bill
| Type of complaint | Medi-Cal/CareAdvantage | Other lines of business |
| Appeal | 60 days | 180 days |
| Grievance | No time limit | 180 days |
Timeframe for processing
| Type | Grievance and appeals processing |
| Standard | 30 calendar days |
| Expedited | 72 hours |
If you have questions about the HPSM's Grievance and Appeals process, please contact HPSM Provider Services at 650-616-2106.