It has been almost one year since the CBAS benefit transitioned into managed care. During this time Santa Clara Family Health Plan received a lot of constructive feedback from our CBAS Providers. As a result of this feedback, beginning September 1, 2013, SCFHP will update the following business practices.
- 835 Electronic Remittance Advice – SCFHP is ready to start testing. Please send the name, email and phone number of your IT representative to providerservices@scfhp, and we will reach out to them to begin the process.
You may call 1-408-874-1791 for more details if needed.
- Retro months – SCFHP does not accept authorizations from other health plans. However, as of September 1, 2013, if a CBAS Provider discovers that a member has switched health plans and the CBAS Provider continued to provide services in good faith, SCFHP will retroactively authorize the services from the beginning of the effective date with SCFHP through the remaining dates of services of the current IPC. SCFHP will conduct an assessment and make a determination for the number of days allowed and services needed. Members must already be receiving services and must have come from another health plan for this retroactivity to be valid and approved. Retroactivity for newly assessed members will not be allowed. CBAS Providers should continue checking a member’s eligibility every month. SCFHP will closely monitor these requests and those CBAS Providers submitting large numbers of retroactive requests will be reviewed on a case by case basis.
Fax your report to: 1-408-874-1957.