Compliance Program

As the local health plan of choice, the mission of HPSJ’s Compliance Program is to support our partners with respect, integrity and clarity. Our vision is to be a trusted partner in Compliance and Service. The program establishes and enforces compliance with ethical standards, HPSJ policies and procedures (P&P), contract requirements and applicable federal and state laws and regulations.

FWA policies & procedures

• CMP30 – Legal Claims and Judicial Review – English
• CMP30 – Legal Claims and Judicial Review – Chinese
• CMP30 – Legal Claims and Judicial Review – Spanish
• CMP23 – Conflict of Interest – English
• CMP23 – Conflict of Interest – Chinese
• CMP23 – Conflict of Interest  – Spanish
• CMP18 – Public Records Act Requests – English
• CMP18 – Public Records Act Requests – Chinese
• CMP18 – Public Records Act Requests – Spanish
• CMP04 – Civil Rights Act – English
• CMP04 – Civil Rights Act – Chinese
• CMP04 – Civil Rights Act – Spanish
• CMP03 – Code of Conduct and Ethics – English
• CMP03 – Code of Conduct and Ethics – Chinese
• CMP03 – Code of Conduct and Ethics – Spanish
• CMP05 – Fraud Waste and Abuse – English
• CMP05 – Fraud Waste and Abuse – Chinese
• CMP05 – Fraud Waste and Abuse – Spanish

HIPAA policies & procedures

• HPA42 – Safeguarding Protected Health Information Personally Identifiable Information – English
• HPA42 – Safeguarding Protected Health Information Personally Identifiable Information – Chinese
• HPA42 – Safeguarding Protected Health Information Personally Identifiable Information – Spanish
• HPA21 – Member Rights for Use and Disclosure of Protected Health Information (PHI) – English
• HPA21 – Member Rights for Use and Disclosure of Protected Health Information (PHI) – Chinese
• HPA21 – Member Rights for Use and Disclosure of Protected Health Information (PHI) – Spanish
• HPA16 – Notice of Privacy Practices – English
• HPA16 – Notice of Privacy Practices – Chinese
• HPA16 – Notice of Privacy Practices – Spanish
• HPA11 – Changes in HIPAA Law – English
• HPA11 – Changes in HIPAA Law – Chinese
• HPA11 – Changes in HIPAA Law – Spanish
• HPA03 – Designation of Privacy Officer and Security Officer – English
• HPA03 – Designation of Privacy Officer and Security Officer – Chinese
• HPA03 – Designation of Privacy Officer and Security Officer – Spanish

Public Forms

• CMP30 – Exhibit A Claims for Damage and Injury – English
• CMP30 – Exhibit A Claims for Damage and Injury- Chinese
• CMP30 – Exhibit A Claims for Damage and Injury – Spanish

Member Forms

• Member Authorization to Revoke a Previous Authorization Spanish.docx
• Member Authorization for Use and Disclosure of PHI Chinese.pdf
• Member Authorization for Use and Disclosure of PHI English.pdf
• Member Authorization for Use and Disclosure of PHI Spanish.pdf
• Member Authorization to Revoke a Previous Authorization English.docx
• Member Caregiver Affidavit Chinese.pdf
• Member Caregiver Affidavit English.pdf
• Member Caregiver Affidavit Spanish.pdf
• Member Request for Accounting of Disclosures Chinese.pdf
• Member Request for Accounting of Disclosures English.pdf
• Member Request for Accounting of Disclosures Spanish.pdf
• Member Request for Confidential Communications English.pdf
• Member Request for Confidential Communications Spanish.pdf
• Member Request for Confidential Communications Chinese.pdf
• Member Request to Access Health Information Chinese.pdf
• Member Request to Access Health Information English.pdf
• Member Request to Access Health Information Spanish.pdf
• Restriction Form Chinese.pdf
• Restriction Form English.pdf
• Restriction Form Spanish.pdf