Authorizations

Inpatient Admissions

Authorizations are based on medical necessity and covered services. Authorizations are contingent upon a member’s eligibility and are not a guarantee of payment. The provider is responsible for verifying a member’s eligibility on the dates of service.

Please verify eligibility by using one of the following methods for each date of service:
  1. Interactive Voice Response: 1(415) 547-7810
  2. SFHP Member Services: 1(800) 288-5555

SFHP’s Utilization Management Department processes authorization requests for members assigned to either the Community Health Network (CHN) or UCSF medical group. In addition, SFHP also processes requests for any Brown & Toland Physicians or Hill Physicians members that request services outside of San Francisco. If your patient is assigned to Brown & Toland Physicians, North East Medical Services, Hill Physicians, Chinese Community Health Care Association, or Kaiser Permanente San Francisco, please refer to the contact information listed below to request services from the delegated group directly. If you are unsure of your patient’s assigned medical group, you can either login to the Provider Portal or call SFHP at 1(415) 547-7818 ext 7101.

Medical GroupPhoneFax
Brown & Toland Physicians 1(415) 972-6002 1(415) 972-4248 (Outpatient Services)
1(415) 972-4239 (Inpatient Admissions)
Community Health Network (CHN)
– SFHN Clinics
– SFCCC Clinics
1(415) 547-7818 ext 7080
1(415) 615-4525 (Inpatient 24/7)
1(415) 357-1292 (Outpatient Services)
1(415) 547-7822 (Inpatient Admissions)
UCSF 1(415) 547-7818 ext 7080
1(415) 615-4525 (Inpatient 24/7)
1(415) 357-1292 (Outpatient Services)
1(415) 547-7822 (Inpatient Admissions)
Chinese Community
Health Care Association (CCHCA)
1(888) 467-4390 option 3 (Outpatient Services)
1(888) 467-4390 option 3 (Inpatient Admissions)
1(888) 467-6802 (Outpatient Services)
1(888) 467-6802 (Inpatient Admissions)
Kaiser Permanente San Francisco 1(415) 833-2801 1(415) 833-2657
North East Medical Services (NEMS) 1(415) 352-5045 1(415) 398-2895
Hill Physicians 1(800) 445-5747 1(925) 820-4311 (Outpatient Services)
1(925) 362-6577 (Inpatient Admissions)

Inpatient Admissions

For members assigned to the UCSF medical group, please submit an authorization request for inpatient admission within 24 hours or by 5:00pm the next business day. To submit an authorization request for inpatient admissions, please fax a facesheet to 1(415) 547-7822. Authorization requests for Inpatient Admissions are processed via Expedited Concurrent Review. If you have additional questions please contact SFHP UM Department at 1(415) 547-7818 ext 7080.

For members assigned to Community Health Network (CHN) please submit an authorization request for inpatient admission within 24 hours or by 5:00pm the next business day if the member is admitted to any hospital except Zuckerberg San Francisco General Hospital and Trauma Center.

Authorization is NOT required for emergency pre-stabilization services delivered in an emergency department or ambulance setting.

How Can I Tell if My Patient Is a Member of SFHP?

If the hospital can identify the patient, they should be able to determine if the patient has Medi-Cal, and if their health plan is SFHP. The hospital can check the patient’s wallet for a SFHP Member ID Card, consult with the family, check the Medi-Cal Website, or access our Provider Portal. You can also call SFHP at 1(415) 547-7810.

How Can I Tell Which Medical Group My Patient Is Assigned To?

Providers can verify a member’s eligibility and assigned medical group by either logging into the Provider Portal or calling SFHP at 1(415) 547-7810.

Pre-Authorizations

To request prior authorization of services, please fill out the UM Prior Authorization Request Form and make sure to include the member’s name, date of birth, CPT/HCPCS codes (include quantity), diagnosis codes, and place of service. In addition, please provide clinical notes to support your request; such as recent notes on the member’s health history and progress, prescriptions, physical exams, and the medical reasons for the requested service. If the requested service will be rendered outside of the member’s assigned medical group, please state why it cannot be performed within the member’s network.

Prior authorization of services is required for all procedures, out-of-network referrals (e.g. a CHN member consulting with a UCSF specialist) and planned inpatient admissions. Referrals for office visits or office consultations within a member’s medical group do NOT require prior authorization.

For more information regarding pre-authorization requests for planned admissions or outpatient services, please click here.

Ancillary Providers (DME, Home Health, Transportation, SNF) for Discharge Planning

If the requested service involves an ancillary provider, please contact the ancillary provider directly and they will submit the authorization request for you. Examples include requests for durable medical equipment, medical supplies, dialysis, home health, home infusion, orthotics, prosthetics, and transportation. Click on the hyperlink to view a list of our contracted Ancillary Providers.

Emergency transportation does NOT require authorization from SFHP. In addition, non-emergent transportation from facility to facility or facility to a residence does NOT require an authorization. However, SFHP requires authorization for non-emergent transportation from a residence to a facility and any non-emergent transportation to/from a Dialysis Center. SFHP will accept retrospective authorization requests (requests submitted after the service was rendered) for transportation services.

For more information regarding pre-authorization requests for ancillary providers, please click here.