Providers
                    
                
                
 
            
                Prior Authorizations
                
            
            
            
            
                Submitting Prior Authorization Requests
            
            
                Referrals
            
            
                Prescription Authorization Requests
                
            
            
            
                Specialty Provider Authorizations
            
            
                PAR List Changes
            
            
                Glucose Monitors
            
            
            
                Claims
                
            
            
            
                Submit Claims
            
            
                Rebill, Correct or Update Claims
            
            
                Submit a Claims Dispute or Appeal
            
            
                Get Paid Faster with EFT/ERA
            
            
                Contact Claims Services
            
            
            
                Provider Resources
                
            
            
            
                Provider Manual
                
            
            
            
                Care Coordination
            
            
                Behavioral Health
            
            
                Provider Incentive Programs
                
            
            
            
                Learning Lab
            
            
                SB855 Training Request
            
            
                HPSM Dental Providers
                
            
            
            
                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
                
            
            
            
                Cultural Competency
                
            
            
            
                Language Assistance Services
                
            
            
            
                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
            
            
            
                Join HPSM Dental
                
            
            
            
            
                Dental Provider Payments
            
            
                Covered Dental Services
            
            
                Benefits of Dental Integration
            
            
                HPSM Dental Mission
            
            
                An Innovative Pilot Program
            
            
            
                Patient Experience
                
            
            
            
                CalAIM at HPSM
                
            
            
            
                Urgent Messages
                
            
            
            
                News & Updates
            
            
                Provider Portal / eReports
            
            
                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.
Resources
Contact
- Phone: 650-616-2170
 - Email: [email protected]