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Announcement of CY2021 quality improvement bonus
As our community continues to face the challenges of the pandemic, Santa Clara Family Health Plan (SCFHP) would like to support your efforts to provide high quality of care to our members during calendar year 2021. We invite you to participate in our one-time quality improvement provider bonus. Providers can earn bonus payments by closing gaps in care for the identified measures between October 1 and December 31, 2021. These payments are in addition to our Provider Performance Program and Prop 56 payments for eligible providers. Program details can be found on our website.
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Get paid for giving flu shots
Your office is the right place to give flu shots to your patients, regardless if they are visiting for another reason. When you meet our criteria for administering influenza vaccines to SCFHP patients aged 19 or older, you may be eligible for Proposition 56 value-based payment from SCFHP:
- Supplemental payment = $25
- At risk add-on payment = $37.50
No more than one payment is granted per patient for vaccinations administered in the first quarter of the calendar year (January through March) or the last quarter of the calendar year (October through December).
If your office is unable to provide the shot, SCFHP members can get one at no cost at any of these pharmacies in Santa Clara County:
- CVS Pharmacy
- Lucky Pharmacy
- Rite Aid
- Safeway Pharmacy
- Walgreens
- Wal-Mart Pharmacy
- Valley Health Center Pharmacies
Use this map to find a participating location.
Questions? Contact ProviderServices@scfhp.com.
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Initial health assessment requirements resume 10/1/2021
The Department of Health Care Services (DHCS) requires primary care providers to resume Initial Health Assessment (IHA) activities starting October 1, 2021. This marks an end to the temporary suspension from December 1, 2019 through September 31, 2021.
Please utilize the Santa Clara Family Health Plan (SCFHP) Member Roster to identify newly enrolled members since December 1, 2019 who are still currently enrolled and coordinate access as needed to facilitate primary care or perinatal care engagement. This includes members who have not received an IHA, and have not engaged in primary care or perinatal services since enrollment.
Member rosters are accessible through SCFHP’s provider portal. Rosters should be reviewed monthly to identify new members along with members with overdue IHA and conduct outreach to schedule the IHA within the required timeframe.
See the revised All Plan Letter, APL 20-004, for more information.
If you have any questions regarding the IHA update, please email ProviderServices@scfhp.com.
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Resuming facility site and medical record review
Effective July 1, 2021, the Department of Health Care Services (DHCS) requires Medi-Cal managed care health plans (MCPs) to resume in-person site reviews, medical record review audits of MCP subcontractors and network providers, and similar monitoring activities that require in-person reviews. DHCS is ending the temporary suspension of the in-person site reviews and medical record review (MRR) audits from April 2020 through June 2021.
Please look out for a call from DHCS Facility Site Review (FSR) Master Trainer (DHCS-MT) Jean Levinson or a health plan representative to schedule your periodic facility site and medical record review audit.
If you have any questions regarding FSR and MRR audit, please email FacilitySiteReview@scfhp.com.
Thank you for taking care of our members in this truly unprecedented time. We appreciate all you do.
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SCFHP's Healthy Moms, Healthy Babies Program
Santa Clara Family Health Plan (SCFHP) is committed to working with you to improve timely prenatal and postpartum care. Providers play an important role in educating pregnant patients about the care they need.
To encourage members to get timely prenatal and postpartum care, SCFHP offers a Healthy Moms, Healthy Babies (HMHB) program that connects members to community resources and provides support. Members can also receive incentives. The following incentives are being offered to members this year:
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- Diaper bag with a co-sleeper: Members can qualify by completing a prenatal visit in their 1st trimester AND attending SCFHP’s Virtual Baby Shower. Virtual Baby Shower is hosted via Zoom every month.
- $40 Gift Card: Members can qualify by completing a postpartum visit within 7-84 days after delivery.
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Enroll your patients in Healthy Moms, Healthy Babies today!
- Fill out the Enrollment Form.
- Attach the member’s medical records indicating they received prenatal care in the first trimester.
- Fax the form and medical records to SCFHP’s Health Education team at 1-408-874-1959.
SCFHP’s Health Education team will follow-up with the member on how to register for the baby shower and how they can qualify for the incentives.
If you have any questions, please e-mail healthed@scfhp.com.
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Voluntary drug recall: Varenicline (Chantix) lots containing nitrosamine
On July 2, 2021, the U.S. Food and Drug Administration (FDA) announced that Pfizer was voluntarily recalling certain lots of the smoking cessation drug, varenicline (Chantix), due to levels of a nitrosamine impurity, called N-nitroso-varenicline, above the FDA’s acceptable intake limit. N-nitroso-varenicline may be associated with a potential increased cancer risk in humans with long-term use. There is no immediate risk to patients taking this medication. The health benefits of stopping smoking outweigh the cancer risk from the nitrosamine impurity in varenicline.
To minimize risk to patients currently taking varenicline, health care professionals should consider the following actions:
- Consider other available treatment options.
- Quarantine any varenicline samples and do not give them to your patients. Contact Pfizer directly regarding product return or disposal.
- Report any adverse reactions with varenicline to the FDA’s MedWatch program.
Read more about this on the FDA website.
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Drug safety update: FDA requests removal of pregnancy contraindication for statins
On July 20, 2021, the U.S. Food and Drug Administration (FDA) requested removal of its strongest warning against using cholesterol-lowering statin medicines in pregnant patients. However, despite the change, most patients should stop statins once they learn they are pregnant.
Patients should not breastfeed when taking a statin because the drug may pass into breast milk and pose a risk to the baby. Patients who require ongoing statin treatment should not breastfeed and instead use other alternatives, such as infant formula.
To minimize risk to patients, health care professionals should consider the following actions:
- Discontinue statins in most pregnant patients, while also considering the ongoing therapeutic needs of the individual patient, especially patients at very high risk of cardiovascular events during pregnancy.
- Discuss with patients whether they may discontinue statins temporarily while breastfeeding. Advise those who require a statin because of their cardiovascular risk that breastfeeding is not recommended since the drug may pass into breast milk.
- Report any adverse reactions with varenicline to the FDA’s MedWatch program.
Read more about this on the FDA website.
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Provider Link
Visit providerportal.scfhp.com to download your member roster and report cards, check authorizations and claims status, and check member eligibility.
- Gaps-in-Care and PPP 2021 report cards are now available on the portal
Interactive Voice Response (IVR)
Call our IVR line at 1-408-874-1473 to verify member eligibility, check claims status based on your TIN, and request confirmation of eligibility verification or claim(s) processed.
Resources on our website
Resources from the County
Find important updates, the COVID-19 case report form, information about PPE, and much more on the Santa Clara County website.
Questions?
Please contact Provider Services at ProviderServices@scfhp.com.
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Providers (unique NPI)
Primary care
Medi-Cal: 804
Cal MediConnect: 534
Specialists
Medi-Cal: 4,634
Cal MediConnect: 3,174
Ancillary
Medi-Cal: 861
Cal MediConnect: 258
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Pharmacies
Medi-Cal: 145
Cal MediConnect: 148
Members
Medi-Cal: 277,136
Cal MediConnect: 10,368
Total: 287,504
As of October 2021
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