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San Francisco Health Plan Claims Billing: Inpatient Services, Facility Outpatient, Medical Supply, Duplicate Billings San Francisco Health Plan Claims Billing Notes described below regard to some points not mentioned in the previous posts devoted to EDI requirements. Inpatient Services, Facility Outpatient, Medical Supply, Duplicate Billings notes are presented in general. Inpatient Services San Francisco Health Read More →

Clean Claims

Clean Claims EDI Processing and Other Health Coverage Cases Clean Claims will be processed by San Francisco Health Plan as submitted in a timely manner for medically necessary and covered services by a participating provider group in accordance with the agreement between SFHP and the provider group for the applicable benefit program. Clean Claims are Read More →

San Francisco Health Plan EDI Claims: Common Requirements San Francisco Health Plan EDI Claims are processed for the following medical groups: San Francisco Community Clinic Consortium, San Francisco Health Network (previously known as the Community Health Network) and UCSF Medical Group. Any delegated medical group must submit encounter EDI data to San Francisco Health Plan Read More →

medical codes

Medical Codes Overview San Francisco Health Plan uses medical codes according to Medi-Cal billing guidelines in addition to Optum coding books application for claim activities. The following procedure medical codes must be used for a claim to be processed: Professional charges – HIPAA compliant HCPCS Level 1 (CPT) & level 2 Inpatient hospital/facility/institutional charges – Read More →

San Francisco Health Plan EDI Requirements

San Francisco Health Plan EDI Requirements: 270/271 Transactions Payer Specific Rules and Limitations San Francisco Health Plan EDI Requirements described below regard to all parties taking part in EDI process with San Francisco Health Plan. San Francisco Health Plan uses real time processing for its EDI transactions to provide immediate responses to its submitters. San Read More →

San Francisco Health Plan EDI

San Francisco Health Plan EDI Testing Process Overview San Francisco Health Plan EDI submitter setup must be completed before the submitter can send eligibility status transactions to the test San Francisco Health Plan EDI environment. San Francisco Health Plan notifies the provider after the successful completion of testing and prepares the provider for production status. During the Read More →

San Francisco Health Plan HIPAA

San Francisco Health Plan HIPAA Compliance General Overview San Francisco Health Plan HIPAA Compliance is viewed as a part of Health Insurance Portability and Accountability Act compliance program for all parties involved in electronic data interchange process in health care industry. Under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Read More →