The Child Health and Disability Prevention (CHDP) is a preventive program that delivers periodic health assessments and services to low income children and youth in California. CHDP provides care coordination to assist families with medical appointment scheduling, transportation, and access to diagnostic and treatment services. To support providers with billing for well check visits, the CHDP program has a PM160 form. There are 3 versions, of the form:

1. Fee-for-Service PM 160 - use this form for Medi-Cal children who are not yet enrolled in a managed care plan or are uninsured,
2. Head Start/State Preschool PM 160
3. The Information Only PM 160 for all managed care plan members

We encourage provides to use the PM160 form as a means to not only collect valuable well child billing information, but also as a means of documentation to support HEDIS data collection. SFHP partners with our providers annually to do HEDIS chart pursuit.  HEDIS enables providers to demonstrate that members are receiving the care they need based on age, gender, and health status. We rely on the PM 160 along with other data sources to demonstrate members are receiving quality care.

We would like to remind our providers that by contract, you are required to complete the Information Only PM 160s and forward them to us.  To obtain additional copies of this form or for instructions on how to complete them for SFHP members, contact provider.relations@sfhp.org.  For the other forms contact the local office at 

CHDP
(415) 575-5712 
fax at (415) 558-5905
30 Van Ness Avenue, Suite 210
San Francisco, CA 94102-6082.

During HEDIS data collection (February – May), SFHP uses encounter data AND the information on the CHDP Information Only PM 160 to look for the following services:

• A complete well check (history & physician, nutritional assessment, and anticipatory guidance and health education),
• BMI percentile, plus height and weight, and
• Immunizations (for those who are not part of the San Francisco Immunization Registry)