News

The situation in Santa Clara County is changing quickly, and we appreciate our providers who continue to provide essential services to our members.

For the most updated information on the coronavirus (COVID-19), please visit the Santa Clara County Public Health Department and Centers for Disease Control websites.

SCFHP remains open

Santa Clara Family Health Plan (SCFHP) operations are continuing during the shelter in place order to maintain services and support for our members and providers. Most staff are now working from home and our lobby is closed to visitors until further notice. Please refer members to our SCFHP Customer Service phone numbers for assistance. For any provider inquiries, please contact Provider Services at providerservices@scfhp.com or call Customer Service at 1-408-874-1788.

Provider self-service tools

• Provider Link: providerportal.scfhp.com
  • Check authorizations and claims status
  • Verify member eligibility
  • Download your member rosters
• Interactive Voice Response (IVR) at 1-408-874-1473
  • Verify member eligibility
  • Check claims status based on your TIN
  • Request fax confirmation of eligibility verification or claim(s) processed

Authorizations

For directly-contracted providers: On April 29, SCFHP communicated that the prior authorization requirement is back in place for dates of service on or after May 1, 2020. Note that COVID-19 testing and treatment still does not require any prior authorization.

Medication

Pharmacies may override refill-too-soon, prior authorization, or step therapy restrictions with Submission Clarification Code (420-DK) = 13. If help is needed to override these restrictions, pharmacies should contact the MedImpact 24/7 Pharmacy Help Desk at 1-800-788-2949.

Additionally, SCFHP members can get a 90-day supply of most prescription maintenance medications mailed to them through MedImpact Direct. Note that Cal MediConnect members pay the same co-pay as a 30-day supply to get a 90-day supply. To find out more about our mail order services, visit www.medimpactdirect.com.

Telehealth

SCFHP will reimburse you at contracted rates for covered services, whether the service is provided in-person or through telehealth.

For more information, including how to bill, please check Provider memos for the latest published memo on telehealth services.

Nurse advice line

Our 24/7 Nurse Advice line is offered at no cost to SCFHP members and is an excellent resource for your patients who have questions about whether they should seek medical care.

• Medi-Cal members can call 1-877-509-0294
• Cal MediConnect members can call 1-844-803-6962

COVID-19 screening and testing

There is no cost to SCFHP members for medically necessary screening and testing for COVID-19. Find information about available testing sites on Santa Clara County's website.

Provider memos

Please check the Provider memos page to download a copy of all of our published memos. Here is a quick list of key memos relating to COVID-19:

• July 28, 2020 – Relief funds available for Medi-Cal providers
• July 23, 2020 – Weekly COVID-19 positive case calls to skilled nursing facilities
• July 15, 2020 – Behavioral health guidance from the Department of Health Care Services
• June 26, 2020 – Catch up on missed/rescheduled well-child/well-care visits
• June 5, 2020 – End-date for payment add-on for COVID-19 patients in LTC/custodial stays
• June 1, 2020 – Prioritizing childhood immunization visits amidst COVID-19
• May 8, 2020 – Payment add-on for COVID-19 patients in LTC/custodial stays
• April 29, 2020 – Updates related to COVID-19 adjustments
• April 17, 2020 – CBAS Temporary alternative services (TAS) and plan of operation
• April 9, 2020 – COVID-19 guidance from Santa Clara County
• April 8, 2020 – CBAS services and activities during the COVID-19 public health emergency
• March 27, 2020 – Reimbursement for telehealth & virtual care for Medi-Cal & Cal MediConnect