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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
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Diabetes Prevention Program
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Potential Quality Issues
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Tobacco Cessation Information and Resources
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Treating Patients Who Use Tobacco
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Provider Education and Trainings
Older Adults and People with Disabilities
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Incentives for Nursing Facilities
HPSM offers bonus payments for quality performance to in-network nursing facilities providing skilled and/or long-term care services to our Medi-Cal and CareAdvantage members. In-network facilities are automatically opted-in to the following upside-only bonuses:
- Nursing Facility Pay-for-Performance ("Nursing Facility P4P") offers bonus payments based on performance in quality metrics designed to improve HPSM member bed access, reduce inpatient and emergency department utilization, and improve care transitions.
- Community Discharge Pay-for-Performance ("Community Discharge P4P") offers long-term care facilities bonus payments for successfully discharging HPSM members with extended institutional stays to a community setting where they remain continuously for six months or more.
Previous Materials
- 2024 Nursing Facility P4P Guidelines – These program guidelines contain comprehensive information on structure and quality performance metrics.
- 2024 Community Discharge P4P Guidelines – This incentive overview provides information on the eligibility requirements for a credited discharge and community retention.