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Claims Submission

Claims Operations Manual, for Claims and IT staff.

Submit Electronic Claims for free with clearinghouse OfficeAlly.

You can also submit electronic claims in the Provider Portal.

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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.