Clinical Services

 

Most Health Maintenance Organizations (HMOs) require referrals or pre-certification for services rendered outside the Primary Care Physician's office. Service requests can be submitted to HealthCare Partners, Management Services Organization (HCPMSO)  electronically via our EZ-Net system, or via fax.

Please see your HealthCare Partners, IPA (HCPIPA) provider manual or call the Provider Services Department for more information on the referral or pre-certification process or to obtain referral request form contact your Provider Service Representative.


Case Management Services

A multi-disciplinary team that includes physicians, nurses, and social workers, provides case management services to members that require individualized, personal attention. Please contact the HCPMSO Clinical Services Department for more information on high-risk case management or disease specific case management programs.


Medical Advisory Committee

The HCPMSO Medical Advisory Committee is composed of HCPIPA participating physicians representing a broad range of specialties. Among other activities, the Medical Advisory Committee participates in the ongoing development and approval of medical criteria. HCPMSO always welcomes additions to this important committee, if you are an HCPIPA participating physician and wish to participate, please contact the HCPMSO Chief Medical Officer for further information.

Affirmative Statement Regarding Incentives

HealthCare Partners wants you to know that:

  1. All Utilization Management (UM) decision is based only on appropriateness of care and service and existence of coverage.

  2. HealthCare Partners does not use incentives to encourage barriers to care and service and does not specifically reward providers or other individuals for issuing denials of coverage or care.

  3. UM decision makers do not receive incentives to encourage decisions that result in underutilization.

All individuals involved in UM decision-making at HealthCare Partners are asked to sign an Affirmative Statement annually.

An Affirmative Statement regarding incentives is distributed to HealthCare Partners staff upon hire and annually thereafter vie email and to practitioners and providers upon initial contracting via the Provider Manual and annually thereafter via our Provider Fast Fax newsletter.

Providers may freely communicate with patients about their treatment, regardless of benefit coverage limitations.