Authorizations

Please select a topic:

• Code Lookup Tool
  The search tool is for services to SFN, CLN, UCSF, and SDN members. For patients in other networks, contact the network directly for authorizations information. Visit page »
• Emergency & Post-Stabilization Services
  Procedures for coordinating care and communicating with emergency departments. Visit page »
• Experimental-Investigational Authorizations
  Authorization requests for experimental/Investigational (E/I) services are never delegated to our medical groups; please use this fax cover sheet and send the request, with all supporting documents, including the Medicaid Attestation Form, to San Francisco Health Plan to process. Any requests for experimental/investigational services will require medical review by SFHP.
• Hospice Services
  Member’s election of hospice services requires timely notification to SFHP. Hospice Notification/Validation form and guidance can be found on this page. Visit page »
• Inpatient Admissions
  Authorizations are based on medical necessity and covered services. More infomration on inpatient admissions can be found on this page. Visit page »
• Medical Criteria
  SFHP uses MCG clinical criteria where available. More specific clinical criteria can be found on this page. Visit page »
• Member Appeals
  A Member Appeal is a request for review of services that has been denied, modified, or delayed by SFHP or one of its contracted Medical Groups. More information on Member Appeals can be found on this page. Visit page »
• Post-Acute and Long-Term Care Admissions
  Procedures for post-acute and long-term care admissions can be found on this page. Visit page »
• Pre-Authorizations
  Authorization Forms for members regarding outpatient services, planned admissions, dialysis, DME, Home Health, transportation, etc can be found on this page. Visit page »
• Transportation Services
  SFHP covers rides for members who need transportation to and from Medi-Cal covered services. Visit page »