Providers: Provider Resources: Claims Submission
Claims Submission
San Francisco Health Plan is preparing to implement a new managed care system that will feature a number of process enhancements and improve our ability to serve you.
A significant area of enhancement is in our Claims submission process. To that end, we are providing you with additional operational details that are important for you to know when submitting claims. Topics covered in this operational detail include helpful tips for accurate claims submission, and a listing of expired Medi-Cal Codes.
Below are links to instructions on how to complete the CMS 1500 and UB-04 Claim Forms. This is for your reference only if you have the need for a refresher or want to look up anything specific regarding completing the claim form.
The CMS 1500 Claim Form
The Center of Medicaid and Medicare Services (CMS) form 1500 must be used to bill SFHP for medical services. The form is used by Physicians and Allied Health Professionals to submit claims for medical services. To view instructions and a sample CMS 1500 with field descriptions, please visit see below.
The UB-04 Claim Form
The UB-04 claim form is used to submit claims for inpatient and outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics, chronic dialysis and Adult Day Health Care). To view instructions and a sample UB-04 with field descriptions, please , please visit see below.
Effective Medi-Cal Codes
The lined rate table below contains codes that are considered covered benefit for Medi-Cal product line. This information is provided by the California Department of Health Care Services as information only for provider reference. While SFHP adopts most of the rate guidelines issued by DHCS, as a Managed Care Organization, SFHP may choose to deviate from these guidelines per SFHP company’s policies.
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