Claims

Claims Submission

Claims Operations Manual, for Claims and IT staff.Claims Manual FAQ

Submit Electronic Claims for free with clearinghouse OfficeAlly.

You can also submit electronic claims in the Provider Portal.

Provider Login

National Provider Identifier

SFHP requires your billing NPI in its system to process claims and/or encounters. This form is not a provider contract. Please complete the National Provider Identifier form with a copy of your IRS-W9 form and send to:

San Francisco Health Plan
Provider Relations
Fax: 1(415) 615-6450
P.O. Box 194247
San Francisco, CA 94119-4247

To avoid delays in the processing of claims and correspondence, please ensure that all requested documentation is submitted timely. Please allow five business days for the processing of your request.

Claim Forms

Below are links to instructions on how to complete the CMS 1500 and UB-04 Claim Forms. This is for your reference only if you have the need for a refresher or want to look up anything specific regarding completing the claim form.

The CMS 1500 Claim Form

The Center of Medicaid and Medicare Services (CMS) form 1500 must be used to bill SFHP for medical services. The form is used by Physicians and Allied Health Professionals to submit claims for medical services. To view instructions and a sample CMS 1500 with field descriptions, please see the below links:

The UB-04 Claim Form

The UB-04 claim form is used to submit claims for inpatient and outpatient services by institutional facilities (for example, outpatient departments, rural health clinics, chronic dialysis, and adult day health care). To view instructions and a sample UB-04 with field descriptions, please see the below links:

Effective Medi-Cal Codes

The lined rate table below contains codes that are considered covered benefit for the Medi-Cal product line. This information is provided by the California Department of Health Care Services (DHCS) as information only for provider reference. While SFHP adopts most of the rate guidelines issues by DHCS, as a Managed Care Organization, SFHP may choose to deviate from these guidelines per SFHP company’s policies.

San Francisco Health Plan (SFHP) is preparing to implement a new managed care system that will feature a number of process enhancements and improve our ability to serve you.

SFHP Claims Matrix

Patient’s Medical NetworkWho processes claims?
BTP Professional: Brown & Toland
Phone 1(415) 972-6000

Mail claims to:
PO Box 72710,
Oakland, CA 94612- 8910

Facility & DME: SFHP
Phone 1(415) 547-7818 ext. 7115

Mail claims to:
P.O. Box 194247,
San Francisco, CA 94119
CHI Professional, Non-Emergency Transport:
NEMS MSO
Phone 1(415) 352-5186, option 2
Fax 1(866) 930-2290

Mail claims to:
CCHCA Claims Department,
P.O. Box 2118, San Leandro, CA 94577

Facility, DME, Emergency Transportation: CCHP
Phone 1(415) 955-8800
Fax 1(415) 955-8812

Mail claims to:
445 Grant Ave, Suite 700
San Francisco, CA 94108
CHN All claims: SFHP
Phone 1(415) 547-7818 ext. 7115

Mail claims to:
P.O. Box 194247
San Francisco, CA 94119
HIL Professional: Hill Physicians
Phone 1(800) 445-5747

Mail claims to:
PO Box 8001
Park Ridge, IL 60068

Facility & DME: SFHP
Phone 1(415) 547-7818 ext. 7115

Mail claims to:
PO Box 194247
San Francisco, CA 94119
JAD All Claims: CCHP

Phone 1(415) 955-8800

Fax 1(415) 955-8812

Mail claims to:
445 Grant Ave, Suite 700
San Francisco, CA 94108
KSR All claims: Kaiser
Member Services 1(800) 390-3510

Mail claims to:
2425 Geary Blvd
San Francisco, CA 94115
NEM All claims: NEMS MSO

Phone 1(415) 352-5186, Option 2

Fax 1(866) 930-2290

Mail claims to:
2171 Junipero Serra Boulevard
Suite 600
Daly City, CA 94014
NMS (NEMS with SFHN) All claims: NEMS MSO

Phone 1(415) 352-5186, Option 2

Fax 1(866) 930-2290

Mail claims to:
2171 Junipero Serra Boulevard
Suite 600
Daly City, CA 94014
UCS All claims: SFHP

Phone 1(415) 547-7818 ext. 7115

Mail claims to:
P.O. Box 194247
San Francisco, CA 94119

Non-Specialty Mental Heath Benefit Managed by Beacon

Patient’s Medical Network Who processes claims?
All Networks except Kaiser All claims: Beacon

Phone 1(855) 371-8117, Option #

Mail claims to:
5665 Plaza Drive, Suite 400,
Cypress, CA 90630

Vision Benefit Managed by VSP

Patient’s Medical Network Who processes claims?
All Networks except Kaiser All claims: VSP

Phone 1(800)742-6907, Option 3

Mail claims to:
P.O Box 385018 Birmingham,
Alabama 35238-5018