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Authorizations

Transportation Services

San Francisco Health Plan (SFHP) covers rides for members who need transportation to and from covered services. This includes transportation to medical, dental, family planning, and substance use disorder services. The transportation benefit is also available for picking up prescriptions and medical supplies.
SFHP covers two types of transportation:

Arranging Member Transportation

SFHP partners with Modivcare to arrange both NEMT and NMT. As a provider, you have two ways to arrange transportation for a member—online or over the phone.

TripCare – Online Scheduling

TripCare is Modivcare’s online patient transportation management system. Through TripCare you can request single trips or standing orders, search and check the status of trip requests, and more.

First-time users will need to fill out the TripCare Facility Registration Form. Once you have an account, you can login and request a ride.

For more information about requesting a ride through TripCare, including training videos, visit the TripCare resource center.

Phone Scheduling

SFHP and Modivcare are here to support transportation request needs.

If you prefer to request transportation over the phone, you may call:
Modivcare Facility Line at 1(866) 529-2128

For escalations you may call:
Modivcare Escalation Line at 1(866) 779-0569

Please note, before requesting NEMT, SFHP must approve the service and have a Provider Certification Statement (PCS) form on file. NMT does not require pre-approval.

For more information about arranging transportation from a discharging facility, see Hospital Discharge.

Non-Emergency Medical Transportation (NEMT)

NEMT is a covered benefit for SFHP Medi-Cal and Healthy Workers HMO members. SFHP’s NEMT benefit is available to members when their medical and/or physical condition (i.e. functional limitation) makes using typical forms of public and private transportation harmful to their health.

NEMT includes these modes of transit:

  • Wheelchair Van
  • Gurney/Litter Van
  • Ambulance
  • Air Ambulance

NEMT Requires a Prescription

You can find SFHP’s Authorization Request for Non-Emergency Transportation (NEMT) and Physician Certification Statement (PCS) form here. Please make sure all mandatory fields on the form are complete. If all fields are not completed, SFHP cannot approve the transportation.

The form must be completed by a physician, dentist, podiatrist, mental health provider, substance use disorder provider, or a physician extender (i.e., physician assistant, nurse practitioner, certified midwives, physical/occupational therapist). Nurses and Social Workers may NOT prescribe NEMT services.

For more information on completing the PCS form and NEMT, please refer to our FAQ document. Except for Facility-to-Facility transfers, all NEMT requests require a PCS form.

Please submit NEMT requests no later than five (5) business days before a member’s scheduled appointment. Urgent requests should be submitted as soon as possible.

NEMT Coordination

SFHP partners with Modivcare to arrange NEMT. SFHP can also provide transportation coordination as needed. Please contact SFHP Transportation Coordinator at 1(415) 547-7807 or email nemt@sfhp.org.

Non-Medical Transportation (NMT)

NMT is a covered benefit for SFHP Medi-Cal members only. NMT does not include transportation of people who are sick, injured, recovering from sickness, or otherwise incapacitated. NMT uses a car, taxi, bus, or other public or private ways of getting members to and from covered Medi-Cal services.

NMT includes these modes of transit:

  • Public Transportation/Mass Transit
  • Ambulatory Curb-to-Curb (member can walk and does not need support)
  • Ambulatory Door-to-Door (member can walk with use of a walker, cane, or crutches, and does need support)
  • Private Vehicle arranged by patient (additional verification information needed for approval)

NMT does not require a prescription. NMT services are available when a member attests that they have no other way to get to their Medi-Cal covered service.

To request NMT for a member you may request the ride through TripCare, contact the Modivcare Facility Line at 1(866) 529-2128, or contact SFHP’s Customer Service department at 1(415) 547-7800, Monday – Friday, from 8:30am – 5:30pm Pacific Time.

Hospital Discharges

When a member is being discharged from a facility, you may request transportation by calling Modivcare at 1(866) 529-2128 or through the TripCare Portal. Modivcare’s transportation provider has up to three (3) hours from the time of the request to pick up the member.

NEMT requires a prescription. Fax a completed Physician Certification Statement (PCS) form to SFHP.
NMT does not require a prescription.

Response Time and Coordination

Standard Response Time: Modivcare will call the discharging facility within 60 minutes (or within 30 minutes for ER discharges) to provide an Estimated Time of Arrival (ETA) or to let you know that transportation is still being arranged.

When ETA Exceeds Limits

If the ETA exceeds 3 hours (or 1 hour for ED discharges) or if a hospital’s contracted provider can transport the member sooner, the trip may be assigned to the hospital’s contracted provider. The contracted provider must confirm their availability via a recorded Modivcare line. Modivcare will cover the transportation costs.

Handling Transportation Delays or No Shows

If there are delays in transportation, or if the designated transportation provider does not arrive within 30 minutes of the provided ETA and another provider is available on-site (even if outside the Modivcare network), the facility can request a new trip number by contacting the Modivcare Facility Line at 1(866) 529-2128. Provide the new trip number to the on-site provider so they can bill Modivcare directly.

How To Make a Transportation Escalation

If you do not receive a call back or are experiencing excessive hold time, contact the Modivcare Escalation Line at 1(866) 779-0569 and request to speak with a Supervisor for an ETA or status update.

Additional Information

  • Drop-Off Timing: Drivers must drop members off at least 15 minutes before their scheduled appointment. For example, if the appointment is at 10:00am, members should be dropped off no later than 9:45am. Modivcare or SFHP will confirm member’s pick-up time based on how long it takes to get to the appointment.
  • Companion or Personal Care Attendant: If needed, one other person can go with a member to their appointment. When scheduling a member’s appointment, please let us know that someone will be joining the member.
  • Unaccompanied Minors: Transportation is available to unaccompanied minors when California or federal law does not require parental consent for a minor’s service (“minor consent”). For services other than “minor consent” services, SFHP requires written parental or guardian consent for unaccompanied minors to travel alone.
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