Prior AuthorizationsHPSM Dental Providers
Referrals Prescription Authorization Requests Specialty Provider Authorizations PAR List Changes Glucose MonitorsClaims
Submit Claims Rebill, Correct or Update Claims Submit a Claims Dispute or Appeal Get Paid Faster with EFT/ERA Contact Claims ServicesProvider Resources
Provider ManualCare Coordination Behavioral Health Value Based Payment Program
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: PrivacyClinical Guidelines Language Assistance Services
Cultural Competency Get a Phone or Video Interpreter Get Translated Member Materials Language Documentation Requirements Health Literacy Language Training & Resources Provider Language Assistance Checklist Tips for Supporting LGBTQIA+ Patients Interpreter Services RequestProvider 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 Newsletters Pediatric Care Potential Quality Issues Urgent Care Tobacco Cessation Resources Older Adults and People with Disabilities Provider Videos Remote Patient Monitoring
Primary Care Provider Incentive Nursing Facility Incentive Ob-Gyn Incentive Specialists IncentiveLearning Lab
Join HPSM Dental Dental Provider Payments Covered Dental Services Benefits of Dental Integration HPSM Dental Mission An Innovative Pilot ProgramUrgent Messages News & Updates Provider Portal / eReports CalAIM at HPSM Join Our Provider Network Provider Contacts All Provider Tasks
Potential Quality Issues (PQIs)
A PQI is a suspected deviation from provider performance, clinical care or outcome of care. HPSM uses a method to identify, report and process PQIs. If a PQI is detected, we take appropriate actions based upon outcome, risk frequency and severity. This helps us improve the care provided to our members.
Use the resources below to understand HPSM’s method of handling PQIs and refer PQI cases to HPSM.
- Phone: 650-616-2170
- Email: email@example.com