Provider Resources

Provider Manual

The Provider 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, screens, and enrolls all contracted providers who have an independent relationship with the Health Plan and provide care under SFHP’s benefits.  SFHP’s delegated groups are responsible for credentialing, screening, and enrolling providers contracted directly with them to provide services to SFHP members.  Every provider must be credentialed according to the appropriate standards before delivering care to SFHP members.

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

DHCS requires all providers to enroll in Medi-Cal and allows Health Plans and their delegates to create an in-house enrollment option that is substantially equivalent to Medi-Cal’s.  SFHP has created a Medi-Cal equivalent process for providers to enroll through if they choose to not enroll with Medi-Cal.  If you are contracted to see SFHP members through a delegated medical group, contact the medical group to confirm if they are offering a similar process, or if you need to enroll through Medi-Cal directly.

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

For questions about credentialing, email credentialing@sfhp.org or call 1(415) 547-7818 ext 7084.

Individual Practitioner Credentialing

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.