Provider Responsibilities | HPSM Providers

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id="pageNav"> <span class="Providers">Providers</span> <i href="#sideNav" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent=".accordian-menu"></i> </span> <div class="list-group panel" id="sideNav"> <a href="https://www.hpsm.org/provider/authorizations" class="list-group-item dropdown-item collapsed "> Prior Authorizations <i href="#group-198d53406-40bd-40aa-87e0-0db3f5347735" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-135bd4b25-8293-494c-84ae-6452bf4545bb"></i> </a> <div class="collapse" id="group-198d53406-40bd-40aa-87e0-0db3f5347735"> <a href="https://www.hpsm.org/provider/authorizations/submitting-prior-authorization-requests" class="list-group-item strong "> Submitting Prior Authorization Requests </a> <a href="https://www.hpsm.org/provider/authorizations/referrals" class="list-group-item strong "> Referrals </a> <a href="https://www.hpsm.org/provider/authorizations/prescription-drugs" class="list-group-item dropdown-item collapsed "> Prescription Authorization Requests <i href="#group-218ae6b77-5995-4a37-bfd5-197d629766b3" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-298d53406-40bd-40aa-87e0-0db3f5347735"></i> </a> <div class="collapse" id="group-218ae6b77-5995-4a37-bfd5-197d629766b3"> <a href="https://www.hpsm.org/provider/authorizations/prescription-drugs/medi-cal-rx-transition-provider-guide" class="list-group-item strong "> Medi-Cal Rx Transition: Provider Guide </a> </div> <a href="https://www.hpsm.org/provider/authorizations/specialty-provider" class="list-group-item strong "> Specialty Provider Authorizations </a> <a href="https://www.hpsm.org/provider/authorizations/par-list-changes" class="list-group-item strong "> PAR List Changes </a> <a href="https://www.hpsm.org/provider/authorizations/glucose-monitors" class="list-group-item strong "> Glucose Monitors </a> </div> <a href="https://www.hpsm.org/provider/claims" class="list-group-item dropdown-item collapsed "> Claims <i href="#group-18eb62825-f4c4-4657-9dd0-f1fcacb37450" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-135bd4b25-8293-494c-84ae-6452bf4545bb"></i> </a> <div class="collapse" id="group-18eb62825-f4c4-4657-9dd0-f1fcacb37450"> <a href="https://www.hpsm.org/provider/claims/submit-claims" class="list-group-item strong "> Submit Claims </a> <a href="https://www.hpsm.org/provider/claims/update-claims" class="list-group-item strong "> Rebill, Correct or Update Claims </a> <a href="https://www.hpsm.org/provider/claims/disputes-and-appeals" class="list-group-item strong "> Submit a Claims Dispute or Appeal </a> <a href="https://www.hpsm.org/provider/claims/get-paid-faster-with-eft-era" class="list-group-item strong "> Get Paid Faster with EFT/ERA </a> <a href="https://www.hpsm.org/provider/claims/contact-claims" class="list-group-item strong "> Contact Claims Services </a> </div> <a href="https://www.hpsm.org/provider/resources" class="list-group-item dropdown-item collapsed "> Provider Resources <i href="#group-149fc1852-db3d-4a9d-b8ef-a398dd5edc32" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-135bd4b25-8293-494c-84ae-6452bf4545bb"></i> </a> <div class="collapse" id="group-149fc1852-db3d-4a9d-b8ef-a398dd5edc32"> <a href="https://www.hpsm.org/provider/resources/manual" class="list-group-item dropdown-item collapsed "> Provider Manual <i href="#group-236bd343d-c19b-4f7a-843c-6dfacd5ce75b" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-236bd343d-c19b-4f7a-843c-6dfacd5ce75b"> <a href="https://www.hpsm.org/provider/resources/manual/section-1-about-the-provider-manual" class="list-group-item strong "> Section 1: About HPSM </a> <a href="https://www.hpsm.org/provider/resources/manual/customer-support" class="list-group-item strong "> Section 2: Customer Support </a> <a href="https://www.hpsm.org/provider/resources/manual/member-complaints" class="list-group-item strong "> Section 3: Member Complaints </a> <a href="https://www.hpsm.org/provider/resources/manual/claims" class="list-group-item strong "> Section 4: Claims </a> <a href="https://www.hpsm.org/provider/resources/manual/provider-disputes" class="list-group-item strong "> Section 5: Provider Disputes </a> <a href="https://www.hpsm.org/provider/resources/manual/ancillary-services" class="list-group-item strong "> Section 6: Ancillary Services </a> <a href="https://www.hpsm.org/provider/resources/manual/utilization-management" class="list-group-item strong "> Section 7: Utilization Management </a> <a href="https://www.hpsm.org/provider/resources/manual/provider-services" class="list-group-item strong "> Section 8: Provider Services </a> <a href="https://www.hpsm.org/provider/resources/manual/quality-improvement" class="list-group-item strong "> Section 9: Quality Improvement </a> <a href="https://www.hpsm.org/provider/resources/manual/health-education" class="list-group-item strong "> Section 10: Health Education </a> <a href="https://www.hpsm.org/provider/resources/manual/fraud-waste-and-abuse" class="list-group-item strong "> Section 11: Fraud Waste and Abuse </a> <a href="https://www.hpsm.org/provider/resources/manual/privacy" class="list-group-item strong "> Section 12: Privacy </a> </div> <a href="https://www.hpsm.org/provider/resources/guidelines" class="list-group-item dropdown-item collapsed "> Clinical Guidelines <i href="#group-2f8df306c-1d26-42a0-b5fd-331e9d7d1505" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-2f8df306c-1d26-42a0-b5fd-331e9d7d1505"> </div> <a href="https://www.hpsm.org/provider/resources/cultural-competency" class="list-group-item dropdown-item collapsed "> Cultural Competency <i href="#group-2c6b1f100-2700-48b1-bddd-d5cf02a47050" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-2c6b1f100-2700-48b1-bddd-d5cf02a47050"> <a href="https://www.hpsm.org/provider/resources/cultural-competency/tips-for-supporting-lgbtqia-patients" class="list-group-item strong "> Supporting LGBTQIA+ Patients </a> <a href="https://www.hpsm.org/provider/resources/cultural-competency/health-literacy" class="list-group-item strong "> Health Literacy </a> </div> <a href="https://www.hpsm.org/provider/resources/language-services" class="list-group-item dropdown-item collapsed "> Language Assistance Services <i href="#group-2684af506-f6ea-4ab4-ac8e-967ef8805735" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-2684af506-f6ea-4ab4-ac8e-967ef8805735"> <a href="https://www.hpsm.org/provider/resources/language-services/language-interpreter-services" class="list-group-item dropdown-item collapsed "> Language Interpreter Services <i href="#group-3971724d0-311f-4ba6-9813-d90f0059cfbf" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-3684af506-f6ea-4ab4-ac8e-967ef8805735"></i> </a> <div class="collapse" id="group-3971724d0-311f-4ba6-9813-d90f0059cfbf"> <a href="https://www.hpsm.org/provider/resources/language-services/language-interpreter-services/interpreter-services-request" class="list-group-item strong "> In-person Interpreter Services Request Form </a> <a href="https://www.hpsm.org/provider/resources/language-services/language-interpreter-services/get-a-no-cost-ipad" class="list-group-item dropdown-item collapsed "> Get a No-cost iPad <i href="#group-4fff0c431-0258-4f9b-b607-27837bdf4345" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-4971724d0-311f-4ba6-9813-d90f0059cfbf"></i> </a> <div class="collapse" id="group-4fff0c431-0258-4f9b-b607-27837bdf4345"> </div> </div> <a href="https://www.hpsm.org/provider/resources/language-services/get-translated-member-materials" class="list-group-item strong "> Translated & Alternative Format Member Materials </a> <a href="https://www.hpsm.org/provider/resources/language-services/language-documentation-requirements" class="list-group-item strong "> Language Documentation Requirements </a> <a href="https://www.hpsm.org/provider/resources/language-services/language-training-resources" class="list-group-item dropdown-item collapsed "> Language Training and Resources <i href="#group-3fa95ebc1-f27a-4415-bc3c-0765efa59935" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-3684af506-f6ea-4ab4-ac8e-967ef8805735"></i> </a> <div class="collapse" id="group-3fa95ebc1-f27a-4415-bc3c-0765efa59935"> <a 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data-parent="group-25bc380af-3a0c-4750-aba7-b97106a561bd"></i> </a> <div class="collapse" id="group-2bf4fc89c-c2e8-4a7b-8c2e-fa99faed8e19"> </div> <a href="https://www.hpsm.org/provider/urgent-messages/prepare-for-power-shutoffs" class="list-group-item strong "> Prepare for Power Shutoffs </a> </div> <a href="https://www.hpsm.org/provider/news" class="list-group-item strong "> News & Updates </a> <a href="https://www.hpsm.org/provider/portal" class="list-group-item strong "> Provider Portal / eReports </a> <a href="https://www.hpsm.org/provider/join-the-network" class="list-group-item strong "> Join Our Provider Network </a> <a href="https://www.hpsm.org/provider/contact-provider-services" class="list-group-item dropdown-item collapsed "> Provider Contacts <i href="#group-1e0265f57-f2de-4917-b33c-849c70bc8164" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-135bd4b25-8293-494c-84ae-6452bf4545bb"></i> </a> <div class="collapse" id="group-1e0265f57-f2de-4917-b33c-849c70bc8164"> <a href="https://www.hpsm.org/provider/contact/nomination-form" class="list-group-item strong "> Nominate a Colleague </a> </div> <a href="https://www.hpsm.org/provider/all-tasks" class="list-group-item strong "> All Provider Tasks </a> </div> </div> </div> <div class="related-items">  <div class="card"> <h3> </h3> <div class="name-and-phone-list"> <h5> </h5> </div> <div class="name-and-phone-list"> <h5> </h5> </div> <div class="name-and-phone-list"> <h5> </h5> </div> </div> </div> </div> <div class="col-xs-12 col-sm-8 col-sm-pull-4"> <div class="content-area container-fluid-margin"> <div class="sf_cols" data-sf-element="Row"> <div class="sf_colsOut sf_1col_1_100"> <div id="Contentplaceholder_TACCE306D001_Col00" class="sf_colsIn sf_1col_1in_100" data-sf-element="Column 1"> </div> </div> </div> <div > <div class="sfContentBlock sf-Long-text" ><h1>Providers’ responsibilities</h1><h2>in the Grievance and Appeals Process</h2><p>HPSM understands that many complaints arise because of a difference in perception or misunderstanding about a situation. A critical part of resolving a member complaint involves getting a <strong>provider’s perspective about the situation under review</strong>. Here is an overview of the process:<br></p><ul><li>An HPSM Grievance and Appeals Coordinator will contact you if a member files a complaint related to services that you provided</li><li>We want to get your honest opinion about what transpired because we understand that there may be differences of opinion</li><li><strong>Requests for your perspective are not an accusation of wrong-doing</strong>: we will not assume that the member’s perspective represents the full story</li><li>In order to meet the strict timeframes for processing a complaint, the deadline for receipt of your response will be <strong>5 days from the date the Grievance and Appeals Coordinator sends you a request</strong></li></ul><h3>All HPSM members have the right to file complaints</h3><p>Legally, neither HPSM nor providers can discourage members from filing complaints. But beyond legal requirements, we value the grievance and appeals process because it tells us what our members think of HPSM and our providers, which is essential to improving the quality of our services.</p><h3>Provider retaliation against a member filing a complaint is strictly prohibited<br></h3><h4>Examples of prohibited retaliation include:</h4><ul><li>Terminating or threatening to terminate a member from your practice after the member has filed a complaint<br></li><li>Refusing to provide treatment or needed prescription refills to a member because of a complaint filed<br></li><li>Treating the member in a disrespectful, hostile, or otherwise negative manner in response to the member filing a complaint<br></li></ul></div> </div> <div > <div class="sfContentBlock sf-Long-text" ></div> </div> </div> <div class="container-fluid-margin"> </div> </div> </div> </div>  <div class="pre-footer reveal-fade-in"> <div class="container-fluid"> <div class="row"> <div class="col-sm-12"> </div> 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