The San Francisco Medi-Cal office (SF HSA Offices) locations below are listed by area, so you have to scroll down to find the location near you. Box 989009 W. Sacramento CA 95798-9850. Vision Care (glasses and eye exams) - 50 vision service providers. Health Plan Services is also available to discuss arrangements for new contracts. It depends. In a physicians office, surgery center, or other designated facility. If you need help choosing between the two plans, contact the SFHSA usingone of three ways below: Online: healthcareoptions.dhcs.ca.gov/enroll/online. S.F. Medically necessary skilled care; room and board; X-ray, laboratory and other ancillary services; medical social services; drugs, medications, and supplies. PDF with st (FFS) - San Francisco Health Plan Behavioral Health Plan offers an array of services. However, there are no other co-payment, premiums, or out-of-pocket expenses if you see and receive Medi-Cal-covered benefits through a Medi-Cal provider. Doctor Visits 600+ Primary Care Providers to choose from, Vision Care (glasses and eye exams) 50 vision service providers, Regular Check-ups and Immunizations (shots), Hospital and Emergency Room Care seven of the best San Francisco hospitals, Specialty Care 3,000+ Specialists in our network, Language Interpreter Services & Materials in Alternate Formats, Emergency and Post-Stabilization Services, Physical Accessibility Review Survey Resources, Peer Review Physician Credentialing Committee, Behavioral Health Treatment for Autism Spectrum Disorder , Covered through your Vision Service Plan , Diagnostic X-ray and Laboratory Services , Tobacco Cessation Services (Help to Quit Smoking Services) , Prescribed by a licensed doctor or a licensed psychologist; and. Tuesday and Thursday 8:30am 5:00pm Behavioral Health Plan providers are located throughout San Francisco and many are accessible to public transportation. Learn more about our Service Center. The Help Desk will no longer accept requests that are either faxed or emailed. Mail form back to: California Department of Health Care Services. See below. (Note: For a search engine, within this manual, press Control +F), Update Regarding Plan of Care (Treatment Plan) Requirements (September 15, 2011), Client Mental Health Information Form Third Party Information The Department of Justice website includes additional information on fingerprint background checks and live scan sites. Note:Choose your plan within 30 days. As a Medi-Cal member, your eligibility will be reviewed every year. Forms | ACBH Providers Website - acbhcs.org Get Medi-Cal Coverage in San Francisco - San Francisco Health Plan You will also learn what you must do to be eligible for the program. Youll need to provide the information below for all household members. Most people seeking behavioral health services need only basic counseling services. If you dont choose a plan within 30 days, the state will choose one for you. Genetic testing is covered for PKU only. The San Francisco Behavioral Health Plan offers a full range of specialty Behavioral health services provided by a culturally diverse network of community Behavioral health programs, clinics and private psychiatrists, psychologists, and therapists. Some households qualify for both. All self-pay patients at UCSF are eligible for a discount. We do, however, accept payments made through health savings account (HSA)programs. Apply in person at one of the SFHSA office locations listed below. Behavioral Health Treatment Services must be: Call Carelon Behavioral Health toll-free at 1(855) 371-8117for help with finding a provider. TDD (888) 484-7200. Starting on January 1, 2022, Medi-Cal Rx will be responsible for the following pharmacy benefits when billed by a pharmacy on a pharmacy claim: Immunizations, periodic health exams, well-child visits, STD tests, cytology exams, prenatal care. Prior Authorization Requests - San Francisco Health Plan For the best experience, try Chrome or Firefox. Additionally, for each office location below, we have provided a phone number to call in case you have questions. For members under 21 years of age, non-medical transportation such as car, taxi, or bus to get to a medical appointment covered under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. Please read the important information on the back of the Health Plan Choice Form before signing and mailing the Choice Form. Medi-Cal providers and billers may view and download the following This chart below is to help you understand what services are provided by San Francisco Health Plan (SFHP). Extractions, fillings, crowns, root canal. Visit Transaction Services CMC Submission Inquiry on the Internet The new "CMC Submission Inquiry" link on the Medi-Cal website offers submitters the option to check CMC submission status. If you do not choose a plan within 30 days, the State will choose a plan for you. After you are approved for Medi-Cal, you must choose a health care plan and/or provider within 30 days of receiving your packet. Learn more about your health care options and get your Medi-Cal application started today. Beneficiary handbooks are available in paper form without charge upon request within 5 business days by calling the 24/7 Access Line at: (415) 255-3737 or (888 . Visit our Service Center page for more information . To keep yourMedi-Cal,update us by calling(415) 558-4700or emailSFMedi-Cal@sfgov.org. Tuesday and Thursday 8:30am 5:00pm PDF Appointment of Authorized Representative Part A: Tell us about you - DHCS Frames and lenses are not covered. Mail your completed paper application to San Francisco Human Services Agency, P.O Box 7988, San Francisco, CA 94120. Mental health and substance use disorder services, Prescription drugs and laboratory services, Physical and occupational therapyand devices, Preventive and wellness services andchronic disease management. You should look at the Member Handbook for a detailed description of coverage benefits and limitations. Service Center locations:On our map below, click on our three Service Centers for their location details. We also help solve problems you may be having with your health care services. Medi-Cal is a health insurance program for low-income residents of California. Wednesday 8:30am 4:00pm (closes at 3:00pm every 3rd Wednesday of the month), Phone appointments are available on: However, if you do not renew your benefits, it may result in the termination of your Medi-Cal benefits. PDF Member Handbook - San Francisco Health Plan First, you can qualify based on Income. Monday to Friday 8:30am 5:00pm Medi-Cal pays for a wide variety of medical expenses, including: Additionally, depending on how you qualify for Medi-Cal, the program may pay for all of these services (full-scope Medi-Cal) or just some of them (partial-scope Medi-Cal). Health Access Programs Family PACT Program Retroactive Eligibility Certification (DHCS 4001), Health Access Programs Family PACT Program Retroactive Eligibility Certification (Spanish) (DHCS 4001 (SP)), Health Access Programs Family PACT Program Client Eligibility Certification (DHCS 4461), Health Access Programs Family PACT Program Client Eligibility Certification (Spanish) (DHCS 4461 (SP)). Medi-Cal Forms & documents Medi-Cal forms & documents Some of our members' materials are available online. . Covered Services: Provider visits including primary care, specialty care, inpatient and outpatient medical and surgical services. After qualifying for Medi-Cal, you'll receive a Benefits Identification Card (BIC) that you can use to start getting coverage. There is no limitation to the frequency of medically necessary exams by ophthalmologists, nor limitations on the treatment of abnormal retinal exams for any member. ), English | Spanish | Chinese (traditional) | Chinese (simplified) | Vietnamese | Tagalog | Russian, For forms in other languages, please download directly here, PSC-35 Client-Level Report Guidelines for Providing Feedback, Safer Prescribing of Antidepressants Guidelines, Safer Prescribing of Antipsychotics Guideline, Atypical Antipsychotic Metabolic Side Effects Patient Handout, Patient Flyer - Anticholinergics in Chinese | English | Spanish | Tagalog | Vietnamese | Russian, Safer Prescribing of Mood Stabilizers Guideline, Safer Prescribing of Sedative-Hypnotics Guideline, Patient Flyer - Sedative-Hypnotics in Chinese | English | Spanish | Tagalog | Vietnamese | Russian, Patient Flyer - Sedative-Hypnotics and Buprenorphine in Chinese | English | Spanish | Tagalog | Vietnamese | Russian, Patient Flyer - Sedative-Hypnotics and Methadone in Chinese | English | Spanish | Tagalog | Vietnamese | Russian, Sedative-Hypnotic Deprescribing Resources, Stimulant and Non-Stimulant Prescribing Resources, Safer Prescribing of Stimulant and Non-Stimulant Medications Guideline, Substance Use Disorders Prescribing Resources, Approaches to Alcohol Use Disorder Medication-Assisted Treatment Guideline, Patient Flyer - Alcohol Use Disorder Medications in Chinese | English | Spanish | Tagalog | Vietnamese | Russian, Approaches to Cannabis Use Disorder Medication-Assisted Treatment Guideline, Medications for Opioid Use Disorder Guideline, Approaches to Tobacco Use Disorder Medication-Assisted Treatment Guideline, Patient Flyer - Naloxone for Adult | College Party | Older Adult | Pediatric Overdose, Child Youth and Family Prescribing Resources, Safer Use of Psychotropic Medications in Children and Adolescents, Patient Flyer Health Choices Worksheet Medication Assent for Very Young Child | Middle Child | Adolescent, BHS Adult Blood Pressure Monitoring Guideline, Patient Flyer - HTN Toolkit Patient Education Materials Chinese | English | Spanish, DPH Formulary Comparison for Psychiatric Medications December 2018, DPH Formulary Comparison for StimulantMedications December 2018, Initial Risk Assessment Fillable, Face-to-Face, Adult/Older Adult Assessment, Long Form, Fillable, FY 10-11 Substance Abuse NNA/Drug Medical Provider's Cost Report Training, How to Pull Out Actual Units Delivered from Avatar System, Integration Initiative, Community Behavioral Health Services, Laguna Honda Hospital & Rehabilitation Center, Zuckerberg San Francisco General Hospital and Trauma Center, Communicable Disease Control & Prevention, Administration, Programs, Policy & Planning, CPMC Compliance Statement and Healthcare Compliance Report, Health Care Services Master Plan Task Force, Law Enforcement Assisted Diversion San Francisco (LEAD SF), Mental Health San Francisco Implementation Working Group, Sugary Drinks Distributor Tax Advisory Committee, CBO Annual Compliance and Privacy Training, ELM Compliance and Privacy Training instructions, User Agreement for Confidentiality, Data Security and Electronic Signature, For Babies, Children, Adolescents or Businesses, Corporations, Organizations, Health Center - Immunization & Travel Shots, West Nile Virus Prevention & Mosquito Control, Immunization for Babies, Children, Adolescents, Immunization - Training and Presentations, Forms - Medical History Forms - Registration, Children - List of Vaccines Provided By DPH, Women, Infants, & Children (WIC) Supplemental Nutrition Program, Community Behavioral Health Services - General Information, Community Behavioral Health Services - Policies & Procedures, Office of Equity, Social Justice & Multicultural Education (formerly Cultural Competence), Dept. Both provide EHB plus other services. Emergency transportation such as ambulance, when medically necessary. Provider Web Application Medi-Cal Dental Providers can view claim activity, patient history, and financial information. Providers are available who speak Cantonese, Spanish, Vietnamese, Tagalog, Russian, and other languages. Call SFHSA at 1-(415) 558-4700 to have an application mailed to you. Non-Discrimination Policy and Language Access . Apply for Medi-Cal 2. New member? Home | Medi-Cal Managed Care Health Care Options 3. ENROLLMENT AND ASSIGNMENT A. Enrollment and Eligibility - IEHP Medi-Cal members can now fill their prescriptions at Costco: Costco membership is not required to use its pharmacy services. Save my name, email, and website in this browser for the next time I comment. Medi-Cal provides free or low-cost health insurance for eligible individuals. Phone Hours: MondayFriday, 8:30am 5:00pm. iCalifornia Medi-Cal is reader-supported. Counseling, surgical procedures for sterilization, contraceptives, elective abortion. . Pre-Authorizations - San Francisco Health Plan Fill in the to show your choice. Translators are utilized if necessary. The steps below will apply for most Medi-Cal members. Some MCPs may require prior approval for reimbursement, so please first check with your MCP. Frequently Asked Questions. Please submit request using the Web Portal/E-Forms page. If you are asked for payment or have other reasons to suspect fraud, call the Medi-Cal Fraud Hotline (800) 822-6222. Smile, California Visit SmileCalifornia.org to access member resources and learn more about the importance of oral health. You may cancel or change this appointment at any time. You can apply by phone. Additional information may be requested. Medi-Cal increases asset limits starting in July 2022 PDF Medi-Cal Choice Form Please fill in both sides. - DHCS San Francisco Health Plan Customer Service is ready to assist you in the language you prefer to speak. Toll-Free Callers 1(800) 288-5555 What are the 6 Medi-Cal Managed Care Models in California? If the SFHSA determines you qualify and are approved for Medi-Cal, you will receive a packet in the mail with your Medi-Cal ID card. PDF Health Plan Choice Form Instructions - calduals.org All Rights Reserved. In addition to Medi-Cal, you can apply for CalFresh, General Relief, and CalWORKs at the following locations, which are open from 8 a.m. to 5 p.m. Monday through Friday: See below for a list of HSA office locations in San Francisco City & County: 1800 Oakdale Avenue 415 970 7762 (This Service Center is closed). Routine dilated eye exams by VSP optometrists are covered annually every 12 months for diabetic patients. Childrens (pediatric) services, including oral and vision care. All plans provide who same Essential Medical Benefits (EHB) include: Out-patient (ambulatory) aids; Emergency services and hospitalization; Pregnancy and newborn worry; Mental health and substance exercise disorder services Our Enrollment Team offers information and application assistance for Medi-Cal. Community First Choice Option Program (CFCO) - provides personal care and other in home supports for fully Medi-Cal eligible persons who would otherwise need a level of . Medically necessary skilled care (not custodial); nursing care, home visits, physical, occupational, and speech therapy. Medi-Cal Dental Choice Form. Note: Choose your plan within 30 days. and Disclosure Form . Use this form to appoint an individual or organization as your Medi-Cal authorized representative. *The UC Medicare Choice plan is available only to University of California retirees. If you have any questions, please call the Help Desk at 510-567-8181. Medi-Cal | sfhsa.org Your email address will not be published. Anthem Blue Cross: California Health Insurance, Medicare & More San Francisco Health Plan - SF's #1 Choice for Medi-Cal Health Insurance Your authorized representative may act for you on all duties related to your Medi-Cal eligibility and enrollment. Be sure to check out our other articles about Medi-Cal and California Medicaid program, including: Your email address will not be published. 4. The DHCS 6246 form is being discontinued, and providers must register in the Medi-Cal Provider Portal in . Department of Public Health: Community Behavioral Health Services - SF Understand your care options ahead of time so you can save time and money. For additional information about our discount policy, please call the Financial Counseling office at (415) 353-1966. The Member Handbook should be consulted for a detailed description of coverage benefits and limitations. Covered California, California Health Benefit Exchange, and the Covered California Logo are registered trademarks or service marks of Covered California, in the United States. To check on the status of your application, contact your Local SFHSA office (see list of locations above). 24-hour care for emergency services including psychiatric screening, examination and treatment, injury or condition requiring immediate diagnosis in and out of the Plan. Application to Participate in the Family PACT Program (DHCS 4468), Family PACT Program Provider Agreement (DHCS 4469). Department of Public Health: Community Behavioral Health Services - SF Get Medi-Cal Benefits in San Francisco - San Francisco Health Plan In this post, we will provide the list of San Francisco City & County Medi-Cal Office locations, with phone numbers. Chemotherapy, dialysis, and radiation. Note for BCIA 8016: Required for all providers designated by DHCS as "high risk." 1. Main phone number: A Share of Cost (also referred to as a SOC) is the amount of money an individual is responsible to pay towards their medical-related services, supplies, or equipment before Medi-Cal will begin to pay. Medi-Cal is a health insurance program for low-income residents of California. For a list of translated MCED forms by language, please click on the following link: Translated Forms. When to apply: You can apply for Medi-Cal year-round. P.O. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Appointments are now available both in-person and by phone. 1235 Mission Street Monday to Wednesday, 8:00 a.m. to 4:30 p.m. | Friday, 8:00 a.m. to 12:00 p.m. 1440 Harrison Street Thursday, 8:00 a.m. to 4:30 p.m. | Friday, 1:00 p.m. to 4:30 p.m. 170 Otis Street Monday to Friday, 8:00 a.m. to 4:30 p.m. We hope this post on San Francisco County Medi-Cal Office Locations was helpful. There are several ways to qualify for the program. See a full list of Medi-Cal Benefits & Services . Treatment of back and neck pain only. 2023 San Francisco Health Plan. Compare the two so you can pick one that best suits you and your family. Also, you can qualify because you meet certain requirements that relate to your health or age. Vision benefits for children under the age of 21 years include eye exams from an Optometrist once every 24 months. Do whatever you want with a Medi-Cal Choice Form for San Francisco - Health Care Options: fill, sign, print and send online instantly. 24-hour care for emergency services including psychiatric screening, examination and treatment, injury or condition requiring immediate diagnosis in and out of the Plan. Treatment Authorization Forms/Guidelines. To see the income limits, see our post on Medi-Cal income limits. You may find your SFHP provider ID number by contacting Provider Relations or searching our online To request an estimate for the out-of-pocket cost for an upcoming service, please call Financial Counseling's Patient Estimate Program at (844) 678-6831. Electronic Health Care Claim Payment/Advice Receiver Agreement (ANSI ASC X12N 835 Transaction) (DHCS 6246) Update: On June 13, 2023, the Department of Health Care Services (DHCS) announced a freeze on processing paper Electronic Health Care Claim Payment/Advice Receiver Agreement forms. Medi-Cal Managed Care Health Plan Directory - DHCS If you make too much money to qualify for free Medi-Cal, you will have a Share of Cost payment. Customer Service representatives are available Monday through Friday, 8:30am to 5:30pm at any of the following phone numbers: Local Callers 1(415) 547-7800 (Note: Consumer Perception Survey results for AOA & CYF Mental Health Programs are not available for 2020. These are services that have been reviewed and have been shown to work. For the closest Medi-Cal office near you, continue reading below. Submitters can check to see if their batch was deleted, had a partial release or full release. Looks like youre visiting UCSF Health on Internet Explorer. Watch for a letter. Visit page EDI Find information for electronic submission of claims and other HIPAA transactions on this page. The following are brief definitions of the terms and acronyms commonly used in regard to health insurance plans and health maintenance organizations. Medi-Cal Eligibility Division Forms Back to Forms by Program Medi-Cal Eligibility Division (MCED) forms are listed below by form number. Medi-Cal Dental Choice Form. The Medi-Cal office will review the information in your case file. How to we help determine if you qualify for Medi-Cal or other affordable coverage. Dr. Jasleen Kukreja and the Life-Saving Gift of Breath, Care, Convenience and Support at New Cancer Facility, 10 Ways to Get the Most Out of Your Doctors Visit, UCSF Health Ranked Among Nation's Top 10 Hospitals, Aetna (Except Aexcel Network and Better Choice Medicaid), Anthem/BC - Covered California Exchange, IFP & SHOP (Small Business), Anthem Blue Cross/Blue Shield Rare & Complex Cancer Network, Blue Shield Covered California, IFP and SHOP (Small Business) - PPO, Canopy Health/Health Net Canopy Care San Francisco Health Service System, Canopy Health/United Signature Value Harmony, Health Net Smart Care/Canopy Health CanopyCare SFHSS, Health Plan of San Mateo Medi-Cal Managed Care, Health Plan of San Mateo Medicare Advantage, Imperial Health Plan - Medicare Advantage HMO, Kaiser Permanente Added Choice/PHCS Network, Kaiser Permanente Dual Choice/PHCS Network, Multiplan (includes Beech Street and PHCS), Oscar Health Covered CA EPO IFP and Small Business, Private Health Care Systems (PHCS) (via Multiplan), San Francisco Health Plan/SF Cares for Kids, United HealthCare Medicare Advantage/Secure Horizons, United HealthCare/OPTUM/PacifiCare Secure Horizons (Senior Plan), United HealthCare/Signature Value Harmony, Western Health Advantage Covered California. Skilled nursing services are covered from the day of admission and up to one month after the month of admission. Learn moreabout Medi-Cal covered dental services: Select one of two plans offered in San Francisco County. Genetic testing is covered for PKU only. The SFHP Service Center is a place where you can go to get information on health care access options that are available for you and your family. Contact our Enrollment Team by calling1(888) 558-5858Monday Friday, 8:30am to 5:30pm. Home Our Services Health Medi-Cal Medi-Cal Medi-Cal provides free or low-cost health insurance for eligible individuals. The UnitedHealthcare Community Plan serves Medi-Cal recipients in these counties: San Diego; What Medi-Cal Plans Cover. NOTE:Masks are recommended but not requiredwhen visiting our Service Centers to protect our staff, clients, and community. Medi-Cal Choice Form Please fill in both sides. For information about completing and submitting these forms, Covered Outpatient Drugs, including Physician Administered Drugs (PADs). Except in emergency situations, if you use providers that are not in our network, we may not pay for these services. Administrative Offices at 1380 Howard Street, 5th Fl. Call the Medi-Cal office at 1(415) 558-4700 for more information. SFHP covers outpatient laboratory, drugs, supplies and supplements in connection with mental health services. In San Francisco, the Human Services Agency (SFHSA) runs the Medi-Cal program. 1(415) 558-4700. Complete a blank sample electronically to save yourself time and Home Services are available to residents of San Francisco who receive Medi-Cal benefits, San Francisco Health Plan members, and to other San Francisco residents with limited resources. 2 Language Interpreter Services & Materials in Alternate Formats, Emergency and Post-Stabilization Services, Physical Accessibility Review Survey Resources, Peer Review Physician Credentialing Committee, We have several programs and will help you find the right one, Your children may qualify even if they are not legal residents. OB/GYN Services and Pregnancy Care. Medi-Cal Provider Forms. If you have Medi-Cal, you can still go to any provider for abortion services at any time, and for any reason. Benefits provided through California Childrens Services (CCS) for benefits related to CCS eligible conditions. Health Plan Services is also available to discuss arrangements for new contracts. Personal Contact Information Health Plan Choice Form Instructions If you want to choose a different Cal MediConnect plan or choose a Medi-Cal plan, please fill out the Health Plan Choice Form in this Choice Book. 4 sessions of individual, group, or telephone counseling that are each at least 10 minutes long without prior authorization. If you don't, the state will choose one for you. For information and to enroll in SCPI, please contact the California MMIS Fiscal Intermediary by either calling (916) 612-5378. or (916) 601-7402, or emailing SCPI@us.ibm.com.
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