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 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 270, 271 EDI Transactions Examples San Francisco Health Plan 270, 271 EDI transactions are used in tandem: the 270 transaction is used to inquire about the eligibility benefit status of a subscriber, and the 271 transaction is returned in response to that inquiry. San Francisco Health Plan returns detailed eligibility, co-payment, … Read More →
San Francisco Health Plan EDI 276 and 277 Documents (Claim Status Request and Response) San Francisco Health Plan EDI 276 and 277 transactions are used in tandem: the 276 transaction is used to inquire about the current status of a specified claim or claims, and the 277 transaction in a response to that inquiry. San Francisco … Read More →