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Privacy Notice

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule affords members the right to receive a notice that describes how health information may be used and disclosed and how to get access to this information. Heritage Sierra Medical Group (HSMG) is required to send a notice ("Notice of Privacy Practices") to members of our insured Health and Long-Term Care plans.

  • Web Privacy Statement:

    • Personal Information Collection and Use

HSMG welcomes you to our website. All information that is collected on our website is done on a voluntary basis. All non-public personal information that you provide via our website will be used strictly for the purpose stated on the page where it is collected. HSMG will not sell, license, transmit or disclose this information outside of HSMG or our affiliated companies unless (1) required or permitted by law, (2) expressly authorized by you, or (3) necessary to enable HSMG contractors or agents to perform certain functions for us. With all disclosures, we will disclose information consistent with applicable law and regulations and we will require the recipient to protect the information and use it only for the intended purpose.

"Personal Information" is defined as data that is unique to an individual, for example: name, address, member id, date of birth, or telephone number. There may be occasions where we may request personal information on our website in order to provide services or respond to your questions.

  • E-mail Communications

Feedback and questions are always welcome on our website. We have provided e-mail boxes for that purpose. Your feedback and questions will be shared with our customer service representatives and those employees most capable of addressing your feedback and questions.

Please note e-mail, like most, if not all, non-encrypted Internet e-mail communications, may be accessed and viewed by other Internet users, without your knowledge and permission, while in transit to us. For that reason, to protect your privacy, please do not use e-mail to communicate information to us that you consider confidential. If you wish, you may contact us instead via non-cellular telephone at the numbers provided on our Contact Us page or Member Services at (661) 273-7346.

We ave made some locations on our website secure, so you can exchange non-public personal information with us. You will be provided appropriate instructions at each of these locations

  • Linking to Other Sites

HSMG's website may provide links to other websites, that are not owned or maintained by HSMG, that we think might be useful or of interest to you. These other websites will open in a separate browser window. We are not responsible for the privacy practices used by other websites, the content, or accuracy of the other websites. These links to other non-HSMG websites do not constitute or imply endorsement by HSMG of these websites, any products or services described on these sites, or of any material contained in them.

  • Security

HSMG has adopted and adheres to stringent security standards designed to protect non-public personal information at HeritageSMG.com against accidental or unauthorized access or disclosure. Among the safeguards that SMG has developed for this site are administrative, physical and technical barriers that together form a protective firewall around the information stored at this site. We periodically subject our site to simulated intrusion tests and have developed comprehensive disaster recovery plans.

  • Changes to this Statement

HSMG may change this Statement from time to time without notice. This Statement is not intended to and does not create any contractual or other legal rights in or on behalf of any party.

  • Legal Statement

    • Disclaimer

All information provided on this web is "AS IS" without warranty of any kind, either express or implied warranties of merchantability, fitness for a particular purpose, or non-infringement. Some jurisdictions do not allow for the exclusion of implied warranties, so the exclusion above may not apply to you. The data set forth herein is for informational purposes only, and no warranty is made that the information is error-free. Please note that once you leave this site, either by using a link we may have provided for your convenience or by specifying your own destination, HSMG accepts no responsibility for the content, products and/or service provided at these non-HSMG locations. HSMG does not control, endorse, promote, or have any affiliation with any other website unless expressly stated herein.

  • Liability

HSMG will not be held liable to any party for any direct, indirect, special, or other consequential damages arising from any use of this website, or any linked website, including, without limitation, any loss of profits, business interruption, loss of programs or data on your equipment, or otherwise, even if we are expressly advised of the possibility or likelihood of such damages.

  • Changes to This Website

Information may be changed or updated without notice. HSMG has no obligation to update information presented on this website, so information contained herein may be out of date at any given point in time. HSMG may also make improvements and/or changes in the services and/or programs described in this information at any time without notice.

Patient Rights

Utilization Management Affirmative Statement

Heritage Sierra Medical Group does not give financial incentives for UM decision makers and does not encourage denials of coverage or service. Providers may freely communicate with patients about their treatment, regardless of benefit coverage limitations.

Members’ Rights

Members have rights and associated responsibilities in the course of their health care service delivery. All contracted health plans have formal statements of member rights and responsibilities. The following represents some of the rights a member has:

  • Be treated with dignity and respect.

  • Exercise these rights without regard to gender, sexual orientation or cultural, economic, educational, disability status, or religious background.

  • Be provided with information about Heritage Sierra Medical Group, its services, and the health care service delivery process.

  • Be informed of non-emergent cost of care and receive an explanation of the member's financial obligations as appropriate, prior to incurring the expense (including co-payments, deductibles, and co-insurance)

  • Examine and receive an explanation of bills generated for services delivered to the member and payable by member (e.g. non-covered services).

  • Have 24-hour access to the member's primary care physician (or covering physician).

  • Receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each, and prospects for recovery in terms that are understandable to the member, in order to give informed consent or to refuse that course of treatment.

  • Actively participate in decisions regarding the member's health care and treatment plan, regardless of cost or benefit coverage. To the extent permitted by law, this includes the right to refuse any procedure or treatment. If the recommended procedure or treatment is refused, and explanation will be given addressing the effect that this will have on the member's health.

  • Receive reasonable continuity of care and be given timely and sensible responses to questions and requests made for service.

  • Voice complaints or appeals about Heritage Sierra Medical Group or the care it provides.

  • Members have the right to be represented by parents, guardians, family members or other conservators for those who are unable to fully participate in their treatment decisions.

  • Make recommendations regarding Heritage Sierra Medical Group members' rights and responsibilities policies.

  • Upon request, utilization management criteria used to authorize, modify, or deny health care services are available to the public.

Members’ Responsibilities

The following represents some of the responsibilities a member has:

  • Be familiar with the benefits and exclusions of the member's health plan coverage.

  • Provide the member's health care provider with complete and accurate information, which is necessary for the care of the member (to the extent possible).

  • Be on time for all appointments and notify the provider's office as far in advance as possible for appointment cancellation and rescheduling.

  • Report changes in the member's condition according to provider instructions.

  • Inform providers of the member's inability to understand information given to him/her.

  • Treat the health care providers and staff with respect and dignity.

  • Contact the member's primary care physician (or covering physician) for any care, which is needed after that physician's normal office hours.

  • Obtain an authorized referral from the member's primary care physician for a visit to a specialist and/or to receive any specialty care.

  • Follow the treatment plan, which has been developed and agreed upon by the health care provider and member, and understand the health problems and participate in developing mutually agreed upon treatment goals to the degree possible.

  • Be familiar and comply with Heritage Sierra Medical Group's health care service delivery system regarding questions and assistance.

  • Respect the rights, property, and environment of all physicians and Heritage Sierra Medical Group providers, staff, and other members.

  • Pay required co-payment or co-insurance amounts.

  • Choose an Advance Directive to designate the kind of care you wish to receive should you be unable to express your wishes.

UM Criteria

Heritage Sierra Medical Group's Utilization Management review process uses a wide range of criteria, guidelines and reference tools to assist determination of benefit coverage and medical appropriateness. Supporting clinical information, relevant to each particular case is reviewed when making medical necessity coverage determination.

Heritage Sierra Medical Group requires that physicians and health care professionals make medical decisions based on medical needs of members. We do not compensate anyone for denying coverage or service, and we do not use financial incentives to encourage denials of any needed medical service. To prevent inappropriate decision making, Heritage Sierra Medical Group/HPN monitors for under- and over-utilization by analyzing data to identify causes and then takes actions to correct any instances of potential or actual under- or over-utilization.

 

California Language Assistance Program

Health Insurance Plans provide their members who have Limited English Proficiency (LEP) access to both written and spoken language assistance.

Heritage Sierra Medical Group can assist you in obtaining interpreter services while in the medical or clinical setting, helping to enhance the communication and health care experience for our member.

Quality Improvement Program

Heritage Sierra Medical Group (HSMG) composes an annual Quality Improvement Program (QIP) and work plan. The Quality Improvement Program specifies the programs goals, objectives, scope, and organization structure as well as performance standards.

The QIP will monitor and evaluate medical care and services throughout the organization to increase cost-effectiveness. Medical Services, Inpatient Services, Clinical Compliance, Quality Management and contracted Behavioral Health Providers all play an equally important role in accomplishing this goal. Each department at HSMG is responsible for meeting set performance standards, reviewing processes and procedures, to ensure we provide excellent service to our members and providers.

If you would like more information regarding HSMG's Quality Improvement Program, please contact the Quality Management department at (661) 273-7346.

 

Notices:

 

LA Care - Cultural and Linguistic Training:

 

Language Assistance/Interpreter Services:

In accordance with California Assembly Bill 853, all HSMG providers will provide, at no cost to the HSMG member, Language Assistance/Interpreter Services for those that are limited in English proficiency. Ask your physician for assistance if you need help with interpreter services.

HSMG offers TDD/TTY services for deaf, hard of hearing, and speech-impaired members. Please call (toll free): (800) 806-4474 .

 

Disclaimer:

Heritage Sierra Medical Group (HSMG) does not reward or offer incentives to employees or associates to encourage inappropriate under-utilization of services. Rather, HSMG is committed to providing quality care to our members, and therefore:

  • Utilization Management decision making is based only on appropriateness of care and service and existence of coverage.

  • HSMG does not specifically reward practitioners or other individuals for issuing denials of coverage or service care.

  • Financial incentives for UM decision makers do not encourage decisions that result in under-utilization.

 

For any questions regarding the HSMG Utilization Management decision-making or other issues related to the Utilization Management process, please call (661) 273-7346

Quality Improvement 

Heritage Sierra Medical Group (HSMG) composes an annual Quality Improvement Program (QIP) and work plan. The Quality Improvement Program specifies the programs goals, objectives, scope, and organization structure as well as performance standards.

The QIP will monitor and evaluate medical care and services throughout the organization to increase cost-effectiveness. Medical Services, Inpatient Services, Clinical Compliance, Quality Management and contracted Behavioral Health Providers all play an equally important role in accomplishing this goal. Each department at HSMG is responsible for meeting set performance standards, reviewing processes and procedures, to ensure we provide excellent service to our members and providers.

If you would like more information regarding HSMG's Quality Improvement Program, please contact the Quality Management department at (661) 273-0100.

For a list of programs and services covered by QI, go to the Programs and Services section.

Notices:

Policies and Procedures:

Compliance

Heritage Sierra Medical Group (HSMG) takes compliance with Federal, State and local laws, regulations and other requirements extremely seriously. That is why HSMG has fully committed to our Compliance Plan which, which fully outlines the rules that our employees, affiliated providers and vendors must adhere to at all times.

Attestations and Training

Download this form: HPN FDR Compliance Attestation 2020

Compliance Training

Click this link to access the following training modules 2021 Mandated Compliance Training Modules (6)

  • Compliance/Codes of Conduct

  • Fraud, Waste, and Abuse

  • HIPAA Privacy

  • Cyber Security

  • Model of Care

  • Cultural & Linguistics / Disability Sensitivity

INSTRUCTIONS

  1. Click Link above or go directly to: https://www.hpnaco.com/Compliance

  2. Click on “Register” next to “If you don't have an account, please…”
    Complete the registration information including the following information:

    1. Registration Name = Full Name_FDR Name_HSMG (Example: John Smith_USC_HSMG)

    2. Email

    3. Insert Password = “quality”

  3. A registration verification will be sent to the user’s email account;

  4. Click the “Activate Account” button within the email;

  5. Login using the user information created during registration;

  6. Un-click the “I am an HPN Employee and Affiliated Groups’ Employee” checkbox;

  7. Upon completion of all 6 Compliance training modules, the training attestation will be emailed to user;

  8. The system will maintain a copy of the registrants completed certifications for our records.

Corporate Compliance

Heritage Provider Network and Heritage Sierra Medical Group are committed to correcting, detecting, and preventing any violation of law, company policy or Code of Conduct, including incidents related to patient privacy breaches, fraud, waste, and abuse, and other issues of non-compliance. Reports of suspected violations may be made to:

  • Hotline: (855) 625-7894 (toll-free)

  • Email: corporatecompliance@heritagemed.com

  • Fax: (661) 480-2099

  • Mail:
    Attn: Corporate Compliance Officer
    Heritage Provider Network
    44469 10th Street West
    Lancaster, CA 93534

Non-retaliation statement: Heritage Provider Network and Heritage Sierra Medical Group’s code of conduct prohibits any retaliation against any individual for reporting in good-faith a compliance concern.

CMS Publications

Patient Rights
Quality Improvement Program
Quality Improvement
Compliance
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