Emergency and Post-Stabilization Services
Procedures for Emergency and Post-Stabilization Services
- Authorizations are not required for emergency services.
- Referral procedures are available for provision to SFHP members who present to emergency departments for non-emergency services.
- Authorizations are required for post-stabilization services
- For non-contracted hospitals, SFHP does not deny authorization requests for medically necessary post-stabilization services.
- To submit an authorization request for inpatient admissions, please fax a face sheet to 1(415) 547-7822.
- Hospitals shall provide SFHP with notice of an inpatient admission within 24 hours or by 5:00pm the next business day.
- SFHP Contracted and Non-Contracted hospitals may contact SFHP’s Clinical Operations team by calling 1(415) 615-4525 (8:30am — 9:00pm, 7 days a week)
- Upon reaching SFHP Clinical Operations staff, they contact the SFHP Medical Director, as needed, to assist with access issues and respond to hospital inquiries within 30 minutes and, if needed, to coordinate the transfer of a Member whose Emergency Medical Condition is stabilized to an appropriate Network Provider, if necessary.
- After 9:00pm and until 8:30am, the call made to 1(415) 615-4525 is forwarded to the SFHP Medical Director or CMO that is on-call.
- If SFHP systems or protocols fail, SFHP will require a Corrective Action with a remedy and mitigation implemented as soon as possible.