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) and license from the Department of Managed Health Care (DMHC). SFHP meets all DMHC and DHCS requirements.
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.
Credentialing can only occur after a Provider Contract has been negotiated with San Francisco Health Plan. To request a contract, please send an inquiry to [email protected].