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General Provider Information

Find here information for the SCFHP community of healthcare providers...

If you have suggestions on how we might better serve you, please let the Provider Services department know.

TdAP - Whooping Cough Notification

Please view the following information regarding TdAP - Whooping Cough

Webinar Information

Medi-Cal Managed Care health plans in your county invite you to join our provider education teams to learn more about serving seniors and persons with disabilities (SPD). Click here for more information

This training is a collaboration brought to you by Santa Clara Family Health Plan, Health Net, Anthem Blue Cross, Alameda Alliance for Health (Alameda County), San Francisco Health Plan (San Francisco County), and other health plans serving the Medi-Cal Managed Care population.

Register today for our Free Webinar.

Brochures

Learn more about the Pediatric Healthy Lifestyle Center at Santa Clara Valley Medical Center.

Provider Manual

Our provider network is a critical component of our mission to offer affordable healthcare to our community. This manual offers our providers the tools they need to reduce their administrative burden, and ensures they have contact information necessary to reach appropriate SCFHP staff.

As an SCFHP provider, we hope that you and your staff find this manual a useful guide and helpful resource in your day-to-day activities. (Note that this is a secure document whose access requires you to be logged in).

Should you have any questions, require assistance, or want to offer suggestions on how we might improve this manual, please contact your Provider Services Department.

Information Security

Because much of the information available in the provider area is designed specifically for doctors and healthcare professionals, a secure login is required for access. Once logged in, you will notice that the provider menu expands to include such things as forms, newsletter, policies and procedures, frequently asked questions, etc.

To request a secure login ID and password, visit the provider login/registration page.

Medical Authorizations

The function of Medical Authorizations is to ensure that medically necessary services are rendered to our members at the most appropriate level of care, in a timely, effective, and efficient manner through a system that provides control of (and accountability for) service utilization. A "Medically Necessary Service" is defined as a service that is reasonable and necessary to protect life, to prevent illness or significant disability, or to alleviate severe pain through the diagnosis and treatment of disease, illness or injury.

Medi-Cal Fraud and Abuse

Medi-Cal fraud costs taxpayers millions of dollars each year, and can endanger the health of the community. In 1999, the California Department of Healthcare Services (DHCS) established the Medi-Cal Fraud Prevention Bureau to detect, investigate, and resolve fraud and abuse in the Medi-Cal Program.

Fraud and abuse concerns include:

  • use of benefits by non-covered personsStop Medi-Cal Fraud
  • presenting misinformation in order to select one health plan over another
  • charging Medi-Cal beneficiaries for covered services
  • fabrication and/or falsification of claims
  • charges for benefits already included in a capitation payment
  • soliciting, offering, and receiving of kickbacks, bribes, or rebates

Both SCFHP and DHCS have established methods for objectively and systematically evaluating and investigating potential fraud and/or abuse. The system is designed to (1) detect potential fraud through the auditing of claims, prior authorization requests, member and provider complaints, and payment patterns, (2) investigate potential fraud through internal and external auditing, and (3) resolve potential fraud cases through exoneration, the corrective action process, or referral to law enforcement authorities. We appreciate your cooperation in fighting Medi-Cal fraud and abuse; if you suspect someone of Medi-Cal fraud, please call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222.

Becoming an SCFHP Provider

For information on how to become an SCFHP provider, please contact our Provider Services department.

Welcome New SCFHP Providers

We wish to extend a warm welcome to all our new providers.