Provider Information Important
Carelon Provider Training
April 12, 2023
Topic: Emotional Impact of Diabetes
Meeting Link: Click here to join the meeting
Date and Time: Friday April 28, 2023 | 12:00 PM PST
Presenter: Pam Boehm, MSN, RN, Practice Transformation Coach
About: Diabetes is a growing epidemic in the United States that impacts all ages, cultural, and socio-economic groups. Research shows that people diagnosed with diabetes experience higher rates of mental health diagnosis and may experience diabetes distress. Panelist from Carelon Health Options will share information about the prevalence and impact of diabetes and co-occurring behavioral health disorders, diabetes distress, and resources to support providers and patients. Registered Nurse and Practice Transformation Coach, Pam Boehm, has experience supporting providers and patients in various markets and will share evidenced-based assessment tools to identify diabetes distress and provide an overview of treatment interventions.
- Overview of the emotional impact for patients living with diabetes
- Define «Diabetes Distress», identify how to assess for it and how to intervene
- Identify professional and education strategies to employ when working with a person with diabetes needing emotional and behavioral health support
Surviving COVID-19 as a Provider and a Human: Preventing and Healing Compassion Fatigue
February 18, 2020
COVID-19 has complicated our lives and increased stress levels for everyone. This is especially true for health care workers who have been on the frontlines of the pandemic.
Join Beacon Health Options on Wednesday, March 10, 2021 at 12pm to learn about compassion fatigue and tools to build your resiliency. Register here: Meeting Registration – Zoom
Vaccine Information Sources for Medi-Cal and San Francisco
December 29, 2020
Providers are encouraged to check these sources often for the latest information.
DHCS All Plan Letter
- DHCS published All-Plan Letter 20-022 on December 28, which should shortly be available at the APL Publications page. APL 20-022 is also available here .
- Key takeaway: Vaccines will be initially provided by the Federal Government, so there is no reimbursement for the vaccine until that changes. Reimbursement for administration for Medi-Cal patients will be processed in the Medi-Cal fee-for-service (FFS) system.
DHCS news publications
- The Medi-Cal Program published the first of a series of policy news articles on December 22. Additional articles are at the News section for General Medicine.
- Key takeaway: FFS has published rates and is ready for administration claims from eligible providers.
SF DPH vaccine resource
- The San Francisco DPH has important information for SF providers seeking to become a vaccine provider at: sfcdcp.org/covidvax-getready
- Vaccine distribution is in phases following California DPH Allocation Guidelines. Phase 1a, Tiers 2-3 consist mainly of healthcare personnel, so the initial task is for outpatient providers to ensure their own staff are vaccinated.
- Key takeaways: Start the process to become a vaccine provider now – there are several distinct steps involved. Enrollment in CAIR, COVIDReadi, and VaccineFinder are described at the SF DPH page.
CDC Vaccination resource
- The CDC’s site on vaccines includes product information on the US-approved vaccines, training/education, and provider requirements at the Federal level.
- Key takeaway: The Vaccine Storage and Handling Toolkit has been updated with a COVID-19 Vaccine Addendum with best practices for COVID-19 vaccines.
CBAS Temporary Alternative Services (TAS)
July 22, 2020
CBAS Temporary Alternative Services (TAS)
During the COVID-19 pandemic, providers may continue to refer SFHP Medi-Cal members who may potentially qualify for CBAS services. CBAS centers have implemented temporary alternative services (TAS) in order to render telephonic services, meal deliveries, transportation, etc. Providers may complete the CBAS referral form, found here.
Emergency Enrollment into DHCS Medi-Cal for Providers
July 2, 2020
DHCS has streamlined enrollment of providers into the statewide Medi-Cal program. If needed to treat Medi-Cal beneficiaries during the public health emergency, providers can be enrolled in 60-day increments without being subject to some of the requirements for permanent enrollment. Please see the memo here for qualifications and procedures.
Most Medi-Cal terminations suspended until the end of the public health emergency.
June 4, 2020
Most Medi-Cal members whose period of eligibility may be ending will not have to go through the renewal process. These members will remain eligible and will not be placed on hold through the end of the public health emergency. For more details, consult Medi-Cal Enrollment Division Information Letter 20-018 here.
ACEs Aware COVID-19 Outreach Strategies and Resources
June 2, 2020
During this unprecedented time of COVID-19, it is critical for primary care and behavioral health providers to continue to maintain connections and provide care to their patients. This is particularly important for patients who have chronic health conditions, mental health conditions, and who have and/or are currently experiencing Adverse Childhood Experiences (ACEs) or other adversities. Additionally, many people are experiencing stress and anxiety, which can exacerbate and lead to toxic stress-related health conditions.
ACEs Aware has released an outreach guide that you may find helpful for communicating with your patients. Read more here.
For additional resources visit the ACEs Aware COVID-19 resource page: https://www.acesaware.org/heal/covid19/
Outreach to Providers for Facility Closures or Changes Due to COVID-19
April 30, 2020
SFHP is extending outreach to providers within our network to confirm any facility closures or changes due to the COVID-19 pandemic. DHCS requires that health plans confirm details of the COVID-19 impact on member access. If your facility has been impacted by COVID-19 in a way that affects member’s access to care, please contact SFHP immediately at 1(415) 547-7818 ext 7084 or firstname.lastname@example.org. If you have been made aware of providers within SFHP’s network that have been impacted, report this to SFHP immediately. SFHP must ensure that members remain with access to care, and that providers remain supported during this time.
Please provide the following information when reporting changes to member care:
- What’s the facility’s name?
- What date did the change begin?
- Has the site: closed permanently; closed temporarily; become telemedicine-only?
- Approximately how many beneficiaries access care at this site?
- Anticipated date of re-opening, if applicable?
Notice from FBI: Beware of Falsified PPE Certifications
April 28, 2020
The FBI has issued a report that some individuals are exploiting the demand for PPE. These individuals target procurement agents at healthcare organizations and send falsified certifications that the materials have been tested and are suitable for import and use in the United States. The Liaison Information Report (LIR) provides more detail and some best practices to guard against this and similar schemes.
Temporary Housing for Unsheltered COVID-19 Patients
April 20, 2020
Alert: Updated quarantine housing referral process for members experiencing homelessness exposed to or diagnosed with COVID-19 but not requiring hospitalization:
The City and County of San Francisco has secured hotel rooms and other spaces to help individuals exposed to or living with COVID-19 to isolate themselves and prevent transmission to others. Provides can now complete the intake form online to determine if these rooms and spaces can meet the needs you’re their patients and clients. https://covid19isorequest.getcare.com/referral
April 2, 2020
Providers with unsheltered patients who have tested positive for COVID-19 and or awaiting results for COVID-19 tests but not requiring hospitalization can contact the DPH COVID-19 Clinician Consultation team for temporary housing referral. DPH COVID-19 team will do intake and evaluation and then make recommendation to the City’s Emergency Operations Center (EOC). EOC will then provide transportation and supplies for the individual to their quarantine destination.
SFDPH COVID-19 Clinician Consultation Line: (415) 554-2830
More information can be found on SFDPH’s website: https://www.sfcdcp.org/infectious-diseases-a-to-z/coronavirus-2019-novel-coronavirus/coronavirus-2019-information-for-healthcare-providers/
DHCS COVID-19 Response Page
April 1, 2020
DHCS has centralized all guidance for Medi-Cal providers and Medi-Cal Managed Care Plans relating to COVID-19 at the following page: https://www.dhcs.ca.gov/Pages/DHCS-COVID%E2%80%9119-Response.aspx.
Reimbursement for Telehealth Services
March 24, 2020
Reminder for providers that per DMHC All-Plan Letter 20-009, “health plans shall reimburse providers at the same rate, whether a service is provided in-person or through telehealth, if the service is the same regardless of the modality of delivery.”
March 19, 2020
Over the past month and most certainly over the past 2 weeks the entire WIC team has working hard to adjust to the ever evolving crises while continuing to provide essential WIC services to our families. To provide continuity of services and protect our team members we have made the following changes to our operations-
- WIC clinics are physically closed but we are completing all appointments -including new enrollments- over the phone. Families do not need to come to WIC and we are able to load their benefits remotely. For new families we will send their WIC card through mail (They also have the option to stop by just to pick up the card).
- We are still providing breast pumps and pump kits to participants that need them.
- We continue to support families with therapeutic formula needs. Providers can email us the prescription for their patients.
- For prenatal participants- we continue to enroll them in EatSF for additional fruit and vegetable vouchers. The vouchers are being mailed to all those enrolled.
- As more of our team members telecommute/take time off, we will be operating our sites with skeletal crew. Even with the increased volume of calls we haven’t had much issues with backlogs. However if you or a family calls and is unable to reach us, please be assured that our team is working hard to respond back in a timely manner. You can also email us at email@example.com.
- We realize that this maybe be a hard time for many San Francisco families who are experiencing hardships due to lost wages. So please continue to refer them to critical services such as WIC, CalFresh and MediCal.
- If your families share that they are having a hard time purchasing WIC foods or formula at the grocery stores please let us know.
For any questions or concerns, please feel free to reach us @ 1(415) 575-5788 or at firstname.lastname@example.org.
Enroll in Claims Payment via EFT
March 19, 2020
All billing providers should enroll in Electronic Funds Transfer (EFT) for direct deposit of payment for claims. Enrolling in EFT will ensure that delays or interruptions in mail delivery or check printing do not affect payments.
Information and enrollment form for EFT is posted here: https://www.sfhp.org/providers/our-network/edi/
Providers can enroll in EFT with or without Electronic Remittance Advice as well.
March 18, 2020
Effective 3/13/20, SFHP Pharmacy Services notified our Pharmacy Network and our PBM (PerformRx) to authorize early refills for members needing extended medication supplies and we have arranged for medication delivery services from all available pharmacies. In addition, if members need to shelter-in-place at a location outside San Francisco, we are authorizing their medications to be filled from out-of-network pharmacies. Additional coverage for OTC disinfectant solutions and OTC latex gloves for members is now available for you to prescribe for your SFHP members as needed.
Attached is an FAQ – Frequently asked questions with more details. https://www.sfhp.org/wp-content/files/providers/PharmacyProviderFAQ.pdf
SFHP Pharmacy staff are monitoring drug shortages and other access concerns and will provide updates with any new developments. We continue to provide pharmacy phone support 24/7 for our members and providers.
Questions regarding SFHP Pharmacy Services can be directed to our SFHP Pharmacy line for providers at: 1(415) 547-7818, ext 7085, Option 3 or contact our PBM (PerformRx) at (888) 989-0091.
March 17, 2020
COVID-19 Medi-Cal Services and Telehealth Notice (March 17, 2020) includes guidelines for:
- Providing and coding telehealth services
- Providing and coding “brief virtual communications”
- Coding COVID-19 diagnostic tests, and Medi-Cal Fee Schedule rates for these tests
- Diagnosis codes
- General preparedness strategies
March 16, 2020
As of March 1, 2020 SFHP will accept requests for retro authorizations and will review for medical necessity for up to 90 days from original date of service*. Please submit the request for authorization with clinical information justifying medical necessity prior to submitting a claim.
*This information may differ depending on member assignment. Please check with the member’s medical group for complete details
March 16, 2020
Effective immediately, SFHP Care Management staff will suspend community visits (including hospital and clinics) for members enrolled in SFHP’s CM programs.
SFHP CM staff will continue to provide Care Management services over the phone to support members and providers.
Questions regarding SFHP Care Management services can be directed to Care Management hot line at: 1(415) 615-4515.
March 16, 2020
Telehealth may alleviate access challenges for patients experiencing milder respiratory complaints that don’t require a face-to-face evaluation. SFHP members have access, at no cost, to Teladoc® physicians 24/7/365.
SFHP encourages providers to use telehealth services to deliver care when medically appropriate as a means to limit patient’s exposure to others who may be infected with COVID-19 and to alleviate demands for acute care.
As appropriate you may refer your SFHP patients to Teladoc® day or night. To access Teladoc® services please direct patients to SFHP’s website at https://www.sfhp.org/teladoc or call Teladoc® directly at 1(800) 835-2362 or www.teladoc.com/sfhp.
March 18, 2020
March 16, 2020
SFHP has availability of telebehavioral health through Beacon
- SFHP members have free telehealth (via video or telephone) through Teladoc® when triage and screening within 30 minutes is not possible. Teladoc® California-licensed physicians treat simple medical problems and can determine whether patients should seek urgent or emergent services, or instruct patients to seek follow-up care with their regular treating physician. SFHP members have access to telebehavioral health through Beacon.
- Teladoc® physicians can prescribe some medications, but not controlled substances. A one-time registration and health history questionnaire via telephone or online is required. SFHP members may access Teladoc® services by calling 1(800) 835-2362 or visiting sfhp.org/teladoc.
March 9, 2020
Where to Find Information
Up to date information about Coronavirus Disease 2019 (COVID-19), such as symptoms and how to protect yourself can be found here:
- For local information from the San Francisco Department of Public Health (SFDPH), please click here.
- For national information and resources from the national Center for Disease Control and Prevention (CDC), please click here.
When to Contact Your Doctor
The most common symptoms of COVID-19 are:
- cough, and
- shortness of breath
If you have traveled to a country or region with cases of the new virus, and you develop symptoms, call your doctor and tell them about your symptoms and your recent travel.
If you are ill, call your health care provider first, and you may be able to be served by phone without having to go to the doctor’s office.
You can also call a doctor at Teladoc for free any time of the day or night. Learn more at teladoc.com/sfhp or 1(800)835-2362.
Screening and testing for the Coronavirus (COVID-19) are free when medically necessary.
Washing hands well is one of the best ways to stop the spread of COVID-19.
To learn more, see the CDC’s Handwashing website or watch this video that shows all the steps to washing hands well.