Specialty Providers P4P Incentive | Health Plan of San Mateo

<!DOCTYPE html> <html lang="en"> <head> <meta charset="utf-8" /><script type="text/javascript" src="/WebResource.axd?d=DzHrpQl5URXarFHAtrmzFriFBMd7RZ11oeGJx3LwY3bX2255RoLNH_S2V7pP9_syo-K6O6X3AJSr-DPRzhz5pR5G03Hs268wMyeWJI86C-j4L-MUPf3FMNOLmgYz1JeRJpqwejJ3OwYIYiW7VjUNxOzCwk2BMaNPa9Bnyr2ehBWDSzaEE4fq4Esj4b3YZads0&t=637878363900000000"> </script><script type="text/javascript"> (function() { TrackingConsentManager.init('\u003cdiv id=\"tracking-consent-dialog\" style=\"padding:20px;position:relative;z-index:10000000;border:1px solid #ccc;background:#fff;\"\u003e \r\n \r\n\t\u003cp\u003e\u003cstrong\u003eThis site uses cookies\u003c/strong\u003e\u003cbr/\u003e\r\n\t\tOur site uses cookies to improve usability by measuring how users interact with website content. Learn more about our \u003ca title=\"Privacy Policy\" href=\"https://www.hpsm.org/privacy-policy#privacy-policy\"\u003eprivacy policy\u003c/a\u003e and \u003ca title=\"Terms of Use\" href=\"https://www.hpsm.org/privacy-policy#terms-of-use\"\u003ewebsite terms of use\u003c/a\u003e.\u003c/p\u003e\r\n \u003cbutton type=\"button\" onclick=\"TrackingConsentManager.updateUserConsent(true)\" id=\"tracking-consent-dialog-accept\" class=\"btn hpsm-dgreen btn-default\"\u003eAccept\u003c/button\u003e\r\n \u003cbutton type=\"button\" onclick=\"TrackingConsentManager.updateUserConsent(false)\" id=\"tracking-consent-dialog-reject\" class=\"btn hpsm-red btn-default\"\u003eDecline\u003c/button\u003e\r\n\u003c/div\u003e'); })(); </script> <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1" /> <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1" /> <link rel="shortcut icon" href="/favicon.ico">  <script async src="https://www.googletagmanager.com/gtag/js?id=G-MDPME99LW6"></script> <script> window.dataLayer = window.dataLayer || []; function gtag() { dataLayer.push(arguments); } gtag('js', new Date()); gtag('config', 'G-MDPME99LW6'); </script>  <link rel="stylesheet" href="/assets/_css/vendor/bootstrap.css"> <link rel="stylesheet" href="/assets/_css/vendor/jasny-bootstrap.min.css"> <link rel="stylesheet" href="/assets/_css/vendor/bootstrap-responsive-tabs.css"> <link rel="stylesheet" href="/assets/vendor/cubeportfolio/css/cubeportfolio.min.css"> <link rel="stylesheet" href="/assets/vendor/aos/dist/aos.css">  <link rel="stylesheet" href="/assets/vendor/slick-carousel/slick/slick.css"> <link rel="stylesheet" href="/assets/slick/slick-theme.css" /> <link rel="stylesheet" href="/assets/_css/vendor/animate.min.css"> <link rel="stylesheet" href="/assets/_css/style.css">  <link href="https://fonts.googleapis.com/css?family=Source+Sans+Pro:400,400i,700,900|Varela+Round&display=swap&subset=cyrillic" rel="stylesheet"> <script src="https://kit.fontawesome.com/035434d4ff.js" crossorigin="anonymous"></script> <script src="/assets/_js/vendor/jquery-3.6.1.min.js" type="text/javascript"></script> <script type="text/javascript"> function googleTranslateElementInit() { new google.translate.TranslateElement({ pageLanguage: 'en', includedLanguages: 'en,es,zh-TW,tl', layout: google.translate.TranslateElement.InlineLayout.SIMPLE }, 'google_translate_element'); } </script> <script type="text/javascript" src="//translate.google.com/translate_a/element.js?cb=googleTranslateElementInit"></script>  <meta name="google-site-verification" content="S4heGMzIegFIrlzZLx9v974MFAm0rf5wwMDl0sZsvWs" /> <link href="/Frontend-Assembly/Telerik.Sitefinity.Frontend.Search/assets/dist/css/sf-search-box.min.css" rel="stylesheet" type="text/css" /> <title> Specialty Providers P4P Incentive | Health Plan of San Mateo </title><meta property="og:title" content="Specialty Providers P4P Incentive | Health Plan of San Mateo" /><meta property="og:url" content="https://www.hpsm.org/provider/incentive-payments/incentive-payments-for-specialists" /><meta property="og:type" content="website" /><meta property="og:site_name" content="HPSM" /><meta name="Generator" content="Sitefinity 13.3.7640.0 DX" /><link rel="canonical" href="https://www.hpsm.org/provider/incentive-payments/incentive-payments-for-specialists" /></head> <body> <script src="https://code.jquery.com/jquery-3.6.0.min.js" type="text/javascript"></script><script src="https://code.jquery.com/jquery-migrate-3.4.0.min.js" type="text/javascript"></script><script src="/ScriptResource.axd?d=VKaJmfFWDpQxp1_HxsR1qHHo3R6llX0UKpTPGV6M0Vl6uBu7Ga-ZLJ0pq5deMH01j8ziAvs-OGV9d5pP2SMt3votiWnAomBKzbqXrDXrjsHJD8lUfzs3wnyJxLJ0Ogjg68sQnL-nx7sw-9ZnSrtxq_RKRci6uC2oSA4ecglF1qRSxZcxg1QKd_DnBWRTctgNXVW7VfIgEJMQtyPuQrV3lQ2&t=fffffffff13f3712" type="text/javascript"></script> <a href="#" id="scroll" style="display: none;" role="button" aria-label="Back to Top"><img alt="Top" src="/assets/_img/up-arrow.svg" role="presentation" /><span>Top</span></a> <div id="popLocation"></div> <header> <div class="site-search"> <div class="site-search-wrapper"> <p>Search</p> </div> <div class="form-group" role="search"> <script type="text/javascript"> function executeSearch() { var searchBtn = document.getElementById('d57b7a63-4a7a-4b5b-8b5e-cda8b475ca8d'); if (searchBtn) { searchBtn.click(); } } </script> <label for="search"></label> <input type="text" class="form-control" placeholder="Search HPSM.org" id="ad6724e2-bbb2-4189-b522-d2d97c554540" value=""> <span class="global-search-btn" aria-label="Perform search" role="button" onclick="executeSearch();"></span> <button type="button" style="display:none;" id="d57b7a63-4a7a-4b5b-8b5e-cda8b475ca8d">Search</button> <input type="hidden" data-sf-role="resultsUrl" value="/search" /> <input type="hidden" data-sf-role="indexCatalogue" value="main" /> <input type="hidden" data-sf-role="wordsMode" value="AllWords" /> <input type="hidden" data-sf-role="disableSuggestions" value='false' /> <input type="hidden" data-sf-role="minSuggestionLength" value="3" /> <input type="hidden" data-sf-role="suggestionFields" value="Title, Content" /> <input type="hidden" data-sf-role="language" value="en" /> <input type="hidden" data-sf-role="suggestionsRoute" value="/restapi/search/suggestions" /> <input type="hidden" data-sf-role="searchTextBoxId" value='#ad6724e2-bbb2-4189-b522-d2d97c554540' /> <input type="hidden" data-sf-role="searchButtonId" value='#d57b7a63-4a7a-4b5b-8b5e-cda8b475ca8d' /> </div> </div> <nav> <div class="navmenu navmenu-default navmenu-fixed-right"> <button type="button" class="navbar-close" aria-label="Close Main Navigation"> <img alt="close" src="/assets/_img/close.svg" role="presentation" /> </button> <div class="audience-menu"> <div class="list-group panel"> <a id="MemberNavBtn1" href="/member" class="list-group-item strong">Members</a> <a id="ProviderNavBtn1" href="/provider" class="list-group-item strong notranslate">Medical Providers</a> <a id="ProviderNavBtn2" href="/provider/hpsm-dental" class="list-group-item strong notranslate">Dental Providers</a> <a id="CareerNavBtn1" href="/job-seeker" class="list-group-item strong">Career Opportunities</a> </div> </div> <ul class="nav navmenu-nav global-links"> <li><a id="FindaProviderNavBtn1" href="/member/choose-a-provider/find-a-provider"><span class="fas fa-search-location fa-fw"></span> Find a Provider</a></li> <li><a id="MemberPortalNavBtn1" href="/member-portal-login"><span class="fas fa-sign-in-alt fa-fw"></span> Member Login</a></li> <li><a id="ProviderPortalNavBtn1" href="/provider/portal"><span class="fas fa-sign-in-alt fa-fw"></span> <span class="notranslate">Provider Login</span></a></li> <li><a id="AboutUsNavBtn1" href="/about-us"><span class="fas fa-user-friends fa-fw"></span> About HPSM</a></li> <li><a id="CommissionNavBtn1" href="/about-us/governance/commission/meeting-agendas"><span class="far fa-calendar fa-fw"></span> <span class="notranslate">Commission meetings</span></a></li> </ul> </div> <div class="overlay-background" role="presentation"></div> </nav> <div class="canvas"> <div class="navbar navbar-default navbar-top"> <a class="navbar-brand" href="/"><img src="/assets/_img/hpsm-logo.svg" alt="HPSM" /></a> <ul class="nav navbar-nav"> <li class="menu-button"> <button type="button" class="navbar-toggle" aria-label="Open Main Navigation"> <span> <span class="icon-bar"></span> <span class="icon-bar"></span> <span class="icon-bar"></span> </span> <span class="menu-label">Menu</span> </button> </li> <li id="EnterSearchBtn1" class="search-button"><a class="nav-link" href="#" data-text-swap="Close" data-text-original="Search"> Search</a></li> <li class="portal-button"> <a id="FindMedicineMenu" class="nav-link" href="/member/view-my-medication-benefits">Find a Medicine</a> </li> <li id="ProviderSearchBtn1" class="provider-search-button"><a class="nav-link" href="/member/choose-a-provider/find-a-provider">Find a Provider</a></li> <li id="ProviderPortalBtn1" class="portal-button"><a class="nav-link" href="/provider/portal">Provider Login</a></li> <li id="MemberPortalBtn1" class="portal-button"><a class="nav-link" href="/member-portal-login">Member Login</a></li> <li class="announcement-button" id="newAnnouncement"> <a href="#announcementDropdown" data-toggle="collapse" data-parent=".announcement-button" class="collapsed"> <span class="announcement-button-text"> <i class="fa fa-exclamation-triangle" aria-hidden="true"></i> Notice </span> <span class="announcement-count">1</span> </a> </li> </ul> <div id="google_translate_element"></div> </div> <div class="announcement-dropdown list-group panel collapse" id="announcementDropdown" aria-labelledby="newAnnouncement" role="alert"> <div class="wrapper"> <div class="callout callout-danger"> <h3 class="text-danger">Important Notices</h3> <p><div class="row d-flex justify-content-center align-self-center "> <div class="my-1 col-md-4 col-sm-12"> <div class="card matchheight p-1 border border-danger text-center"> <div class="p-1"> <h5 class="mt-1 mb-2 card-title text-navy">HPSM's Updated Privacy Practices</h5> <a class="btn btn-primary btn-sm" href="/docs/default-source/member-notices/hpsm_notice_of_privacy_practices_english.pdf?sfvrsn=cbbeeadd_73">Read now</a> </div> </div> </div> <div class="my-1 col-md-4 col-sm-12"> <div class="card matchheight p-1 border border-danger text-center"> <div class="p-1"> <h5 class="mt-1 mb-2 card-title text-navy">Monkeypox information</h5> <span class="btn-group"><a class="btn btn-primary btn-sm" href="/member/emergency-message/monkeypox-information">Members</a><a class="btn btn-secondary btn-sm" href="/provider/urgent-messages/monkeypox">Providers</a></span> </div> </div> </div> <div class="my-1 col-md-4 col-sm-12"> <div class="card matchheight p-1 border border-danger text-center"> <div class="p-1"> <h5 class="mt-1 mb-2 card-title text-navy">Power Outages</h5> <span class="btn-group"><a class="btn btn-primary btn-sm" href="/member/emergency-message/prepare-for-wildfires-and-power-outages">Members</a><a class="btn btn-secondary btn-sm" href="/provider/urgent-messages/prepare-for-power-shutoffs">Providers</a></span> </div> </div> </div> </div></p> </div> </div> <a class="btn btn-sm" href="#announcementDropdown" data-toggle="collapse" data-parent=".announcement-button" aria-label="Close Announcements" role="button"><i class="fa fa-window-close text-danger" aria-hidden="true"></i> <span class="text-danger">Close</span></a> </div> </div> </header> <main class="main-content"> <div class="container-fluid"> <div class="row"> <div class="col-xs-12 col-sm-4 col-sm-push-8"> <div class="page-navigation"> <img src="/images/default-source/banners/providers.jpg?sfvrsn=7d171421_8" title="Providers" alt="providers" /> <div class="accordian-menu PMS376" role="navigation" aria-labelledby="pageNav"> <span 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 href="https://www.hpsm.org/provider/resources/language-services/language-training-resources/provider-language-assistance-checklist" class="list-group-item strong "> Provider Language Assistance Checklist </a> </div> </div> <a href="https://www.hpsm.org/provider/resources/forms" class="list-group-item dropdown-item collapsed "> Provider Forms <i href="#group-2cc4a9fcf-89a8-400d-8861-036fff50a4a7" class="fa fa-caret-down collapsed" data-toggle="collapse" data-parent="group-249fc1852-db3d-4a9d-b8ef-a398dd5edc32"></i> </a> <div class="collapse" id="group-2cc4a9fcf-89a8-400d-8861-036fff50a4a7"> <a href="https://www.hpsm.org/update-my-information" class="list-group-item strong "> Update My Information </a> </div> <a href="https://www.hpsm.org/provider/directory-search" class="list-group-item strong "> Directory Search </a> <a href="https://www.hpsm.org/provider/formulary-search" class="list-group-item strong "> Formulary Search </a> <a 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 "> 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 active"> 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>Incentive for Specialty Providers</h1><div class="row"><div class="col-md-8 col-sm-12"><p>HPSM offers an incentive for specialty providers  contracted with  Medi-Cal, HealthWorx, CareAdvantage and primary care providers that increases Medi-Cal allowable rates of 175% for certain Medi-Cal specialties. HPSM developed the program to improve access to specialty care, increase utilization, enhance payment data and align reimbursement with market trends. Injectables are not eligible to receive the 175% markup.</p><p>Claims submitted without the appropriate taxonomy code and qualifier code (ZZ or PXC) will pay at the current rate (123% of the allowable Medi-Cal rate). HPSM will not accept claims resubmitted to include the taxonomy code.<br></p></div><div class="col-md-4 col-sm-12 py-2 px-0"><div class="jump-links ml-2"><ul class="fa-ul "><li><span class="fa-li fa fa-arrow-circle-o-right" style="color: rgba(78, 195, 224, 1)"> </span><a href="#Tax" data-sf-ec-immutable="">About taxonomy codes</a></li><li><span class="fa-li fa fa-arrow-circle-o-right" style="color: rgba(78, 195, 224, 1)"> </span><a href="#R" data-sf-ec-immutable="">Resources</a> </li><li><span class="fa-li fa fa-arrow-circle-o-right" style="color: rgba(78, 195, 224, 1)"> </span><a href="#CS" data-sf-ec-immutable="">Claims submissions</a> </li></ul></div></div></div><div class="clearfix"></div><h2 id="Tax">About taxonomy codes</h2><p>Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten-character alphanumeric code that enables providers to identify their specialty at the claim level.</p><p>Taxonomy codes are used when applying for a National Patient Identifier (NPI) with the National Plan and Provider Enumeration System (NPPES).</p><h2 id="R">Resources</h2><ul><li>To find your taxonomy code, use the <a target="_blank" href="https://npiregistry.cms.hhs.gov/search" data-sf-ec-immutable="">National Provider Identifier Search</a>.</li><li>Learn more about Taxonomy at <a href="https://www.cms.gov/data-research/cms-information-technology/data-architecture-engineering/cms-data-taxonomy" target="_blank" data-sf-ec-immutable="" data-sf-marked="">CMS.gov</a>.</li><li>Download the <a target="_blank" href="/docs/default-source/provider-services/provider_specialists_taxonomy_codes.pdf?sfvrsn=4cde35c_12">specialists taxonomy codes for claims submission</a> that HPSM has included in the Specialists Incentive Program.</li><li>OB/GYN Program Guidelines.</li></ul><h2 id="CS">Claims submissions</h2><p>The Specialists Incentive Program will require all selected specialists to include their taxonomy code on the claims form when submitting a paper CMS 1500 claims forms or electronic claims submission (837 files).</p><ul><li>Paper Claims: Enter the taxonomy code in box 33b of the CMS1500 form.</li><li>Electronic Claims (837 file): On the incoming electronic file (837), the segment is “PRV”, on different location/loop with different Code, For Billing / Submitting, loop 2000A, Code “BI” example: PRV*BI*PXC*207N00000X~<br></li></ul><p><br></p></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" height="24" src="https://www.hpsm.org/images/default-source/logos/facebook.svg?Status=Temp&sfvrsn=ac66c4ba_2" role="presentation" alt="facebook" /> </a> <a style="margin-left:1.0rem;" target="_blank" rel="noreferrer" href="https://www.instagram.com/healthplanofsanmateo/"> <img style="display: inline;" width="24" height="24" src="https://www.hpsm.org/images/default-source/logos/instagram.svg?Status=Temp&sfvrsn=d4ddac80_2" role="presentation" alt="instagram" /> </a> </p> </div> </div> <div class="col-xs-12 col-sm-3 col-md-3"> <div> <a id="MemberFooterLink" class="text-lg text-capitalize" title="Members" href="/member">Members</a> <a id="ProviderFooterLink" class="text-lg notranslate" title="Providers" href="/provider">Providers</a> <a id="HealthTipsFooterLink" class="text-lg" title="Health Tips" href="/health-tips">Health Tips</a> <a id="CareerFooterLink" class="text-lg" title="Careers" href="/job-seeker">Careers</a> <a id="AboutUsFooterLink" class="text-lg" title="About HPSM" href="/about-us">About HPSM</a> </div> </div> <div class="col-xs-12 col-sm-3 col-md-3"> <div> <ul style="line-height:1.5rem;"> <li class="nav-item"><a id="ContactFooterLink" href="/contact-us">Contact Us</a></li> <li class="nav-item"><a id="LanguageFooterLink" href="https://www.hpsm.org/docs/default-source/member-notices/language-assistance-tagline.pdf">Language Assistance</a></li> <li class="nav-item"><a id="PrivacyFooterLink" href="/privacy-policy">Privacy Policy</a></li> <li class="nav-item"><a id="NDNFooterLink" href="/non-discrimination-notice">Non-Discrimination Notice</a></li> <li class="nav-item"><a id="AccessibilityFooterLink" href="/help/accessibility">Accessibility Statement</a></li> <li class="nav-item"><a id="ComplianceFooterLink" href="/about-us/governance/compliance">Compliance</a></li> </ul> </div> </div> <div class="col-xs-12 col-sm-3 col-md-3"> <div> <div id="tagline"> <p>Helping San Mateo County’s vulnerable and underinsured residents live the healthiest lives possible.</p> </div> <br /><br /> <small class="notranslate">Ⓒ 2024 Health Plan of San Mateo</small> </div> </div> </div> </footer>  <script src="/assets/_js/vendor/jquery.easing.1.3.js" type="text/javascript"></script> <script src="/assets/_js/vendor/bootstrap.min.js" type="text/javascript"></script> <script src="/assets/_js/vendor/jasny-bootstrap.js" type="text/javascript"></script> <script src="/assets/_js/vendor/enquire.min.js" type="text/javascript"></script> <script src="/assets/_js/vendor/jQuery.headroom.js" type="text/javascript"></script> <script src="/assets/_js/vendor/hoverIntent.js"></script> <script src="/assets/_js/vendor/jquery.matchHeight.js" type="text/javascript"></script> <script src="https://unpkg.com/scrollreveal/dist/scrollreveal.min.js"></script> <script src="/assets/_js/vendor/bootstrap-responsive-tabs.min.js" type="text/javascript"></script> <script src="/assets/vendor/cubeportfolio/js/jquery.cubeportfolio.min.js"></script>  <script src="/assets/_js/hs.core.js"></script> <script src="/assets/_js/hs.cubeportfolio.js"></script> <script src="/assets/_js/main.js" type="text/javascript"></script> <script src="/Frontend-Assembly/Telerik.Sitefinity.Frontend.Search/Mvc/Scripts/SearchBox/Search-box.min.js?v=MTMuMy43NjQwLjA%3d" type="text/javascript"></script> </body> </html>

CINXE.COM

Specialty Providers P4P Incentive | Health Plan of San Mateo