Authorizations

Post-Acute Admissions

For ALL Post-Acute Placement Requests (skilled and non-skilled): Please contact SFHP’s Post-Acute team directly at 1(415) 615-4583 or postacutehelp@sfhp.org. The Post-Acute team manages placement requests to Long-term Acute Care (LTAC), Acute Rehabilitation, Sub-acute, and Skilled Nursing Facilities. Clinical notes to support your request, such as recent notes on the member’s health history and progress, therapy evaluations, prescriptions, physical exams, and justification or the medical reason for the requested admission are required. A list of contracted post-acute facilities can be found on the provider directory page or via fax or email upon request. All contracted facilities must be referred to and have declined before an approval to a non-contracted facility is considered.

SFHP’s SNF memo is available here and shared with facilities upon each acceptance.

Long-Term Care Admissions

For SNF or Subacute Long-Term Care Requests (Continuation of Care): A new prior authorization is required for Long-Term Care (LTC) admissions that exceed the month of admission and month after. To request prior authorization for continued SNF or Subacute care services, please complete a LTC Request Form. Clinical notes to support your request, such as recent notes on the member’s health history and progress, prescriptions, physical exams, MDS and MC 171 are required. Please fax your request to SFHP’s LTC team at 1(415) 943-9700. SFHP’s LTC memo is available here. Please direct any questions you may have about this process to the Long-Term Care team at 1(415) 615-4530 or email longtermcarehelp@sfhp.org.

*For new LTC placements from an acute care hospital, see section “Post-Acute Admissions” above.

For Intermediate Care Facility for the Developmentally Disabled (ICF/DD) Requests: Authorization responsibility is shared between SFHP and the Regional Center. The Regional Center is responsible for conducting medical necessity placement reviews for eligible members. SFHP is responsible for providing administrative authorization, a notice of determination, and claim payment (for approved services). Authorization requests are initiated by the ICF/DD facility using the ICF/DD Authorization Request Form. Prior to requesting authorization from SFHP, the Regional Center must render a placement decision and complete the Certification for Special Treatment Program Services form (HS 231). The ICF/DD Authorization Request and HS 231 Forms are required for SFHP authorization.

Long-Term Services and Supports (LTSS) Liaison

SFHP’s LTSS liaison is available to assist facilities in addressing claim and payment inquiries as well as assists with care transitions to best support members’ needs. SFHP’s LTSS Liaison can be reached directly at LTSSLiaison@sfhp.org.