![]() Please refer to the provider memo: New billing process for Medicare crossover claims through COBA for additional information. This means that you will not need to submit most claims for members with Medicare Fee-for-Service and Medi-Cal through SCFHP. Submit all non-delegated claims to SCFHP (see SCFHP claims billing)Įffective May 18, 2020, most Medicare dual crossover claims will be submitted through a Coordination of Benefits Agreement (COBA) with the Centers for Medicare & Medicaid Services (CMS). Submit all facility and non-delegated claims to SCFHP (see SCFHP claims billing) Valley Health Plan (VHP): TIMELY FILING LIMITS BY PAYOR PROFESSIONALSubmit all facility and non-delegated claims to SCFHP (see SCFHP claims billing) Premier Care of Northern California:ĭelegated for in-area professional claims (services within Santa Clara, Santa Cruz, Alameda, San Mateo and/or San Benito Counties) and all family planning services.ĬHDP, DME, hearing aids, home health, inpatient and outpatient facility, and injectables over $250 are non-delegated claims and are the responsibility of SCFHP. Submit all Medi-Cal claims to SCFHP (see SCFHP claims billing) Physicians Medical Group of San Jose (PMG):ĭelegated for in-area professional claims (services within Santa Clara, Santa Cruz, Alameda, and San Mateo Counties) and all family planning services.Įmergency physicians services, child health and disability prevention (CHDP), durable medical equipment (DME), hearing aids, home health, inpatient and outpatient facility, inpatient pathology, and injectables over $250 are non-delegated claims and are the responsibility of SCFHP.Įlectronic claim submission – PMG accepts electronic claims through the following clearinghouses: Submit all non-delegated claims to SCFHP (see SCFHP claims billing) Palo Alto Medical Foundation Non-medical transportation (NMT) and non-emergency medical transportation (NEMT), and CBAS are non-delegated claims and are the responsibility of SCFHP. Submit all non-delegated claims to SCFHP (see SCFHP claims billing) North East Medical Services (NEMS):ĭelegated for all professional and facility claims. You may find the information to identify a delegated provider agreement below by delegate: Kaiser: ![]() The information below can assist you in submitting claims to the correct location, which will alleviate the need for SCFHP or our delegates to redirect a claim that was received at the incorrect location. Each agreement has unique characteristics that affect how and where you submit claims. Medi-Calįor Medi-Cal members, SCFHP has a number of delegated relationships with its provider network. TIMELY FILING LIMITS BY PAYOR HOW TOPlease refer to the instructions in the Claims Billing section on this page for specifics about how to submit claims directly to SCFHP. ![]() SCFHP does not delegate claims payment for Cal MediConnect. ![]()
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