The situation in Santa Clara County is changing quickly, and we appreciate our providers who continue to provide essential services to our members.
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 email@example.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
For directly-contracted providers: As of March 31, 2020, the suspension of all provider-requested medical (inpatient and outpatient), pharmaceutical, and durable medical equipment prior authorization requests will be extended until April 30, 2020. No provider-requested prior authorization is required for medically necessary covered services, medications, or equipment provided during this period. This does not apply to requested services that are excluded from coverage. Please see the member handbooks for more information about the services that are excluded: Cal MediConnect Member Handbook, Medi-Cal Member Handbook.
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.
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.
COVID-19 screening and testing
There is no cost to SCFHP members for medically necessary screening and testing for COVID-19.