Health Alerts

Health Alerts

COVID-19 Provider Updates Important

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.”


WIC Services

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 wic@sfdph.org.
  • 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 wic@sfdph.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.


Pharmacy Notice

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/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.


Telehealth Notice

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

Click here for more details »


Retrospective Authorization

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


Care Management

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.


Telehealth Reminder

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 or call Teladoc® directly at 1(800) 835-2362 or www.teladoc.com/sfhp.


Beacon

March 18, 2020

Behavioral Health

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.

COVID-19

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:

  •   fever,
  •   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
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.