Potential Quality Issues (PQIs)

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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 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href="https://www.hpsm.org/provider/resources/diabetes-prevention-program" class="list-group-item dropdown-item collapsed "> Diabetes Prevention Program <i href="#group-256465877-c942-4d46-ac8e-5ddd06ccea2c" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-256465877-c942-4d46-ac8e-5ddd06ccea2c"> <a href="https://www.hpsm.org/provider/resources/diabetes-prevention-program/dpp-patient-referral-form" class="list-group-item strong "> DPP Patient Referral Form </a> <a href="https://www.hpsm.org/provider/resources/diabetes-prevention-program/smmc-diabetes-program" class="list-group-item strong "> SMMC Diabetes Program </a> </div> <a href="https://www.hpsm.org/provider/resources/end-of-life-care" class="list-group-item strong "> End of Life Care </a> <a href="https://www.hpsm.org/provider/resources/grievance-appeals-process" class="list-group-item dropdown-item collapsed "> Grievance & Appeals Process <i href="#group-2b3455ac9-2dbe-49d9-8122-e8aa4896b81a" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-2b3455ac9-2dbe-49d9-8122-e8aa4896b81a"> <a href="https://www.hpsm.org/provider/resources/grievance-appeals-process/what-is-a-complaint" class="list-group-item strong "> What is a complaint? </a> <a href="https://www.hpsm.org/provider/resources/grievance-appeals-process/providers-responsibilities" class="list-group-item strong "> Providers’ responsibilities </a> <a href="https://www.hpsm.org/provider/resources/grievance-appeals-process/response-timeframes" class="list-group-item strong "> Response timeframes </a> <a href="https://www.hpsm.org/provider/resources/grievance-appeals-process/contact-g-a-unit" class="list-group-item strong "> Contact HPSM's G&A Unit </a> </div> <a href="https://www.hpsm.org/provider/resources/healthcare-effectiveness-data-and-information-set" class="list-group-item strong "> Healthcare Effectiveness Data and Information Set </a> <a href="https://www.hpsm.org/provider/resources/home-health-care" class="list-group-item strong "> Home Health Care </a> <a href="https://www.hpsm.org/provider/resources/initial-health-assessment" class="list-group-item dropdown-item collapsed "> Initial Health Appointment <i href="#group-26a1fa7ee-3bb9-43c0-9906-a87e96f3a1a2" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-26a1fa7ee-3bb9-43c0-9906-a87e96f3a1a2"> <a href="https://www.hpsm.org/provider/resources/initial-health-assessment/2023-iha-changes" class="list-group-item strong "> 2023 IHA Changes </a> </div> <a href="https://www.hpsm.org/provider/resources/maternal-health" class="list-group-item strong "> Maternal Care </a> <a href="https://www.hpsm.org/provider/resources/medical-record-and-facility-site-reviews" class="list-group-item strong "> Medical Record and Facility Site Reviews </a> <a href="https://www.hpsm.org/provider/resources/member-handbooks" class="list-group-item strong "> Member Handbooks </a> <a href="https://www.hpsm.org/provider/resources/healthmatters-md" class="list-group-item dropdown-item collapsed "> HEALTHmatters MD <i href="#group-2d14f87bd-a03d-43fe-a11c-bb7bbda4fbb3" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-2d14f87bd-a03d-43fe-a11c-bb7bbda4fbb3"> <a href="https://www.hpsm.org/provider/resources/healthmatters-md/newsletters" class="list-group-item strong "> Newsletter Archive </a> <a href="https://www.hpsm.org/provider/resources/healthmatters-md/provider-notices" class="list-group-item strong "> Provider Notices </a> </div> <a href="https://www.hpsm.org/provider/resources/pediatric-care" class="list-group-item strong "> Pediatric Care </a> <a href="https://www.hpsm.org/provider/resources/potential-quality-issues" class="list-group-item strong active"> Potential Quality Issues </a> <a href="https://www.hpsm.org/provider/resources/urgent-care" class="list-group-item strong "> Urgent Care </a> <a href="https://www.hpsm.org/provider/resources/tobacco-cessation-resources" class="list-group-item dropdown-item collapsed "> Tobacco Cessation Information and Resources <i href="#group-2a2e64e2f-647c-4816-96ef-61c922e9f031" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-2a2e64e2f-647c-4816-96ef-61c922e9f031"> <a href="https://www.hpsm.org/provider/resources/tobacco-cessation-resources/identifying-tobacco-users" class="list-group-item strong "> Identifying Tobacco Users </a> <a href="https://www.hpsm.org/provider/resources/tobacco-cessation-resources/treating-patients-who-use-tobacco" class="list-group-item strong "> Treating Patients Who Use Tobacco </a> <a href="https://www.hpsm.org/provider/resources/tobacco-cessation-resources/vulnerable-populations" class="list-group-item strong "> Vulnerable Populations </a> <a href="https://www.hpsm.org/provider/resources/tobacco-cessation-resources/provider-education-and-trainings" class="list-group-item strong "> Provider Education and Trainings </a> </div> <a href="https://www.hpsm.org/provider/resources/older-adults-and-persons-with-disabilities" class="list-group-item strong "> Older Adults and People with Disabilities </a> <a href="https://www.hpsm.org/provider/videos" class="list-group-item strong "> Provider Videos </a> <a href="https://www.hpsm.org/provider/resources/remote-patient-monitoring" class="list-group-item strong "> Remote Patient Monitoring </a> </div> <a href="https://www.hpsm.org/provider/care-coordination" class="list-group-item strong "> Care Coordination </a> <a href="https://www.hpsm.org/provider/behavioral-health" class="list-group-item strong "> Behavioral Health </a> <a href="https://www.hpsm.org/provider/incentive-payments" class="list-group-item dropdown-item collapsed "> Provider Incentive Programs <i href="#group-120d1dcb7-63c0-4f34-80c4-9114c53527ed" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-135bd4b25-8293-494c-84ae-6452bf4545bb"></i> </a> <div class="collapse" id="group-120d1dcb7-63c0-4f34-80c4-9114c53527ed"> <a href="https://www.hpsm.org/provider/incentive-payments/incentive-payments-for-primary-care-providers" class="list-group-item dropdown-item collapsed "> Incentives for Primary Care Providers <i href="#group-268f151c5-4ff8-46cb-a0d0-b9162ad1b71a" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-220d1dcb7-63c0-4f34-80c4-9114c53527ed"></i> </a> <div class="collapse" id="group-268f151c5-4ff8-46cb-a0d0-b9162ad1b71a"> <a href="https://www.hpsm.org/provider/incentive-payments/incentive-payments-for-primary-care-providers/care-gap-p4p-incentive-program-interest-form" class="list-group-item strong "> Care Gap P4P Incentive Program Interest Form </a> </div> <a href="https://www.hpsm.org/provider/incentive-payments/incentive-payments-for-nursing-facilities" class="list-group-item strong "> Incentives for Nursing Facilities </a> <a href="https://www.hpsm.org/provider/incentive-payments/incentive-payments-for-specialists" class="list-group-item strong "> Incentives for Specialty Providers  </a> </div> <a href="https://www.hpsm.org/provider/learning-lab" class="list-group-item strong "> Learning Lab </a> <a href="https://www.hpsm.org/provider/sb855-training-request" class="list-group-item strong "> SB855 Training Request </a> <a href="https://www.hpsm.org/provider/hpsm-dental" class="list-group-item dropdown-item collapsed "> HPSM Dental Providers <i href="#group-174f36575-3241-48b1-9e76-4b1c1d28f8cf" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-135bd4b25-8293-494c-84ae-6452bf4545bb"></i> </a> <div class="collapse" id="group-174f36575-3241-48b1-9e76-4b1c1d28f8cf"> <a href="https://www.hpsm.org/provider/hpsm-dental/join-hpsm-dental" class="list-group-item dropdown-item collapsed "> Join HPSM Dental <i href="#group-2388b7643-c933-4415-be9e-c964394a836a" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-274f36575-3241-48b1-9e76-4b1c1d28f8cf"></i> </a> <div class="collapse" id="group-2388b7643-c933-4415-be9e-c964394a836a"> </div> <a href="https://www.hpsm.org/provider/hpsm-dental/payments" class="list-group-item strong "> Dental Provider Payments </a> <a href="https://www.hpsm.org/provider/hpsm-dental/covered-dental-services" class="list-group-item strong "> Covered Dental Services </a> <a href="https://www.hpsm.org/provider/hpsm-dental/benefits-of-dental-integration" class="list-group-item strong "> Benefits of Dental Integration </a> <a href="https://www.hpsm.org/provider/hpsm-dental/mission" class="list-group-item strong "> HPSM Dental Mission </a> <a href="https://www.hpsm.org/provider/hpsm-dental/an-innovative-pilot-program" class="list-group-item strong "> An Innovative Pilot Program </a> </div> <a href="https://www.hpsm.org/provider/patient-experience" class="list-group-item strong "> Patient Experience </a> <a href="https://www.hpsm.org/provider/calaim-at-hpsm" class="list-group-item dropdown-item collapsed "> CalAIM at HPSM <i href="#group-167f12e56-7522-48b7-aaa7-68b7a007b163" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-135bd4b25-8293-494c-84ae-6452bf4545bb"></i> </a> <div class="collapse" id="group-167f12e56-7522-48b7-aaa7-68b7a007b163"> <a href="https://www.hpsm.org/provider/calaim-at-hpsm/enhanced-care-management-(ecm)" class="list-group-item strong "> Enhanced Care Management (ECM) </a> <a href="https://www.hpsm.org/provider/calaim-at-hpsm/community-supports-(cs)" class="list-group-item strong "> Community Supports (CS) </a> </div> <a href="https://www.hpsm.org/provider/urgent-messages" class="list-group-item dropdown-item collapsed "> Urgent Messages <i href="#group-15bc380af-3a0c-4750-aba7-b97106a561bd" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-135bd4b25-8293-494c-84ae-6452bf4545bb"></i> </a> <div class="collapse" id="group-15bc380af-3a0c-4750-aba7-b97106a561bd"> <a href="https://www.hpsm.org/provider/urgent-messages/provider-covid-19-resources" class="list-group-item strong "> Provider COVID-19 Resources </a> <a href="https://www.hpsm.org/provider/urgent-messages/monkeypox" class="list-group-item dropdown-item collapsed "> Mpox (Monkeypox) <i href="#group-2bf4fc89c-c2e8-4a7b-8c2e-fa99faed8e19" class="fa fa-caret-down collapsed" data-toggle="collapse" 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>Potential Quality Issues (PQIs)</h1><p>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. </p><p><strong>Use the resources below to understand HPSM’s method of handling PQIs and refer PQI cases to HPSM. </strong></p><h4>Resources</h4><ul><li><a href="/docs/default-source/provider-services/provider_toolkit_pqi_introduction.pdf?sfvrsn=4ca8e8a5_6" title="Introduction to Potential Quality Issues">Introduction to Potential Quality Issues</a></li><li><a href="/docs/default-source/provider-forms/provider_toolkit_pqi_referral_form.pdf?sfvrsn=1df3c513_18" title="PQI Referral Form">PQI Referral Form</a></li><li><a href="/docs/default-source/provider-services/provider_toolkit_pqi_case_leveling_grid.pdf?sfvrsn=df12f26d_6" title="PQI Case Leveling Grid">PQI Case Leveling Grid</a></li></ul><h4>Contact </h4><ul><li>Phone: <span class="phone">650-616-2170</span></li><li><span class="phone"></span>Email: <a href="mailto:pqireferralrequest@hpsm.org">pqireferralrequest@hpsm.org</a></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> </div> </div> </div> </main> <footer> <div class="row pb-3"> <div class="col-xs-12 col-sm-3 col-md-3"> <div> <img style="width:150px;" role="presentation" src="/assets/_img/hpsm-logo.png" /> <p class="notranslate"><span class="block">801 Gateway Blvd., Suite 100</span><span class="block">South San Francisco, CA 94080</span></p> <p> Phone: <span style="color:#2e9947;">650-616-0050</span> <br />Fax: <span style="color:#2e9947;">650-616-0060</span> <br />TTY:  <span style="color:#2e9947;">1-800-735-2929</span> <br />or dial <span style="color:#2e9947;">7-1-1</span> </p> <p class="mt-3"> <a style="margin-left:0.5rem;margin-right:1.0rem;" rel="noreferrer" target="_blank" href="https://www.facebook.com/healthplanofsanmateo"> <img style="display: inline;" width="24" 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Potential Quality Issues (PQIs) | HPSM Providers