San Francisco Health Plan

Automated line providers use to verify SFHP eligibility for each date of service and the member's assigned medical group (the Provider Portal is the alternative).

SFHP UM handles authorizations for members assigned to San Francisco Health Network, Community Clinic Network, UCSF or the SFHP Direct Network, plus out-of-San Francisco requests for Brown & Toland or Hill members. Members in AAMG, Brown & Toland, Hill, Jade or NEMS otherwise use their medical group's UM. The page gives the UM extension as 7080 in the medical-group table and 77080 in the inpatient text, so no extension is stored; ask at the main menu.

Listed in the SFHP UM phone column for SFN, CLN and UCSF members, available 8:30 a.m.–9:00 p.m. seven days a week.

Fax a face sheet within 24 hours (or by 5 p.m. next business day) for inpatient admissions of members assigned to UCSF, SFN, CLN or SDN; processed via expedited concurrent review. Emergency pre-stabilization services need no authorization.

SFHP processes all claims for SFN, CLN, UCSF and SFHP Direct Network members, and facility/DME claims for Brown & Toland and Hill members (professional claims for those groups go to the medical group). The same department explains provider dispute (PDR) submission, Monday–Friday 8:30 a.m.–5:30 p.m.

Send the NPI Registration (or bulk enumeration) form with IRS W-9 so SFHP has the billing NPI needed to process claims; not a provider contract. Allow five business days.

Questions about the SFHP provider network and contracting.

Provider or member referrals to SFHP care management for Medi-Cal members.

Provider or member referrals to SFHP care management for SFHP Care Plus (D-SNP) members.

Member coverage questions; TTY 711. Also used for Medi-Cal qualification questions. The inpatient-admissions page also lists the toll-free number for eligibility.

Member line for SFHP Care Plus D-SNP members; TTY 711.

Member nurse advice line, 24/7.