SFHP Policies & Procedures

San Francisco Health Plan’s (SFHP) Policies and Procedures are based on regulations and guidelines of DHCS, DMHC, NCQA, and CMS. These documents provide essential information about our health care practices.

See below to review specific policies and procedures.

• CO-01 UM Authorization & NOA Letters »
• CO-02 Skilled Nursing & Custodial LTC Admissions »
• CO-03 Major Organ Transplants »
• CO-04 Second Opinion Medical Services »
• CO-06 Abortion Services »
• CO-10 Dental Anesthesia »
• CO-12 Emergency Urgent Medical & Psychiatric Services »
• CO-14 Mastectomy Coverage »
• CO-19 Specialty Care & Standing Referrals »
• CO-22 Authorization Requests »
• CO-26 Discharge Planning »
• CO-28 Transportation »
• CO-31 Breastfeeding & Lactation Management »
• CO-32 Hospice Care »
• CO-33 EPSDT & EPSDT Supplemental Services »
• CO-38 DME Criteria »
• CO-47 Clinical Trials »
• CO-48 Repatriation »
• CO-54 Evaluation of New Technology »
• CO-57 UM Clinical Criteria »
• CO-58 Palliative Care »
• CO-59 Experimental or Investigational Services »
• CO-61 Gender Affirmation »
• CO-63 MD Access »
• CO-64 Information Integrity »
• CO-65 Medicare Notices for Discharge or Coverage Termination »
• CO-66 Prior Authorization »
• CO-67 Post Stabilization and Inpatient Concurrent Review Authorizations »
• CO-68 Out-of-Network Coverage »
• CO-69 Physician Administered Drugs (Pads)/Medicare Part B Drugs »
• CO-70 Readmissions »
• CO-71 Community-Based Adult Services »
• CO-73 Exception Requests for Physician-Administered Drugs »