Provider Resources

Network Operations Manual

The Network Operations Manual is designed to help providers and medical groups navigate SFHP policies, benefits, and programs. The manual is updated periodically and a link to the most current version can be found on this page. If you have any questions about the manual’s content please email Provider Relations or call 1(415) 547-7818 ext 7084.

The San Francisco Health Plan Claims Department produces a Claims Operations Manual for providers, facilities and medical groups to reference when billing for services. If you have any questions about this manual, please contact the Claims Department or call 1(415) 547-7818 ext 7115.

Provider Credentialing

San Francisco Health Plan (SFHP) credentials providers who have an independent relationship with the Health Plan and provide care under SFHP’s medical benefit.  Providers who practice within the inpatient setting or free-standing facilities while providing care to SFHP members are exempt from the SFHP credentialing and re-credentialing process.

Credentialing and recredentialing standards used by SFHP are based on federal and state requirements, and comply with SFHP’s contract with the Department of Managed Health Care (DMHC) and the Department of Health Care Services (DHCS). SFHP meets all DMHC and DHCS requirements, and adopts current National Committee for Quality Assurance (NCQA) credentialing  accreditation standards.

Credentialing and recredentialing requirements are applied to all licensed practitioners credentialed by SFHP and its delegated medical groups, including non-physician medical practitioners. SFHP requires every practitioner contracted to provide care to SFHP members to be credentialed according to the appropriate standards before delivering care to SFHP members.

SFHP assures that all information obtained during credentialing and recredentialing activities remains confidential, except as required by law.

The Physician Advisory/Peer Review/Credentialing Committee (PAC) and SFHP Governing Board review the Credentialing Program annually and applicable SFHP Credentialing Policies and Procedures.

Individual Practitioner Credentialing

Clinic (PCP, Family Planning, Acupuncture, etc.)

Ancillary Providers

Please email your completed and signed application and ­all required documents to credentialing@sfhp.org. If you prefer to use mail, please send documents to:

Provider Network Operations Department
San Francisco Health Plan
P.O. Box 194247
San Francisco, CA  94119

Thank you for your interest in participating in the SFHP provider network. Please do not hesitate to contact us at 1(415) 615-5631 or credentialing@sfhp.org if you have any questions.