Working with Medi-Cal Members & Understanding Member Rights
Provider Manuals and Resources
- Network Operations Manual for patient coordination & clinical staff
- Summary of Key information for Providers is a brief overview of a Medi-Cal provider’s obligations.
- Community Resources for other services SFHP members may qualify for
- Claims Operations Manual for claims and IT staff
- Submit Electronic Claims for free with clearinghouse OfficeAlly
Working with San Francisco Health Plan
- As a Medi-Cal provider, SFHP or its Medical Group Representative is required to visit you and conduct a facility site review every three years. SFHP also conducts the ADA access tool, due every three years, and loaded your information in our Medi-Cal Provider Directory and on our website.
- SFHP sends monthly provider bulletins to your office to inform you of any important changes to our programs.
- You may access SFHP’s website at sfhp.org at any time for provider resources.
- You may contact SFHP at 1(415) 547-7800 for assistance Monday through Friday, from 8:30am to 5:30pm.
- Our Utilization Management team makes certain that the services and procedures our members receive and the facilities they use, are timely and appropriate. If you have any questions about our utilization review, please call us at 1(415) 547-7800 or 1(800) 288-5555, Monday through Friday, from 8:30am to 5:30pm. Our TDD line for the hearing impaired is 1(415) 547-7830 or 1(888) 883-7347.
- Non-English speaking or limited English proficient Medi-Cal members have the right to receive oral interpreter services on a 24-hour basis at no cost to them.
- Interpreter services may be provided through an in-person interpreter or telephone language service.
- Your medical group is required to provide this service to SFHP Medi-Cal members.
- You must document a member’s preferred language (if other than English) in the medical record.
- You must document the request and refusal of language/interpretation services in the member’s medical record.
- You must discourage members from using friends, family, and minors as interpreters.
- Learn about options for accessing interpreter services in the Bay Area for your patients
- Tips on working with interpreters
Click here to access SFHP’s Health Education Library. You may view and download various health education documents as well as useful resources including health education classes, videos, program, tips, and tools. Materials are available in English, Spanish, Chinese, and Vietnamese.
What is a grievance?
A grievance is any expression of dissatisfaction regarding the plan and/or provider, including quality of care, concerns, disputes, and requests for reconsideration or appeal made by the member or the member’s representative.
How to submit a grievance
Grievance forms are available at San Francisco Health Plan’s website in English, Spanish, Chinese, Vietnamese, and Russian. Grievances can be submitted by mail, phone, or fax to:
San Francisco Health Plan
P.O. Box 194247
San Francisco, CA 94119
Phone: 1(800) 288-5555 or 1(415) 457-7800
Fax: 1(415) 547-7825
If an SFHP member files a grievance with your office, please contact SFHP’s Customer Service at 1(415) 457-7800 or contact SFHP’s Grievance Coordinator immediately to refer the grievance.