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Sign up today for Payspan
Be sure to sign up today for Payspan, Santa Clara Family Health Plan’s new partner for electronic remittance advice and electronic funds transfer payments. Registration instructions are available on hard copy checks issued since November 15, 2021, by emailing providersupport@payspanhealth.com for a registration code, or by visiting https://www.payspanhealth.com/RequestRegCode. Please see our provider memo for more details.
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SCFHP launching CalAIM initiatives - Enhanced Care Management and Community Supports
CalAIM, or California Advancing and Innovating Medi-Cal, is the Department of Health Care Services’ (DHCS) multi-year process to transform Medi-Cal. Effective January 1, 2022, Santa Clara Family Health Plan (SCFHP) is launching two new CalAIM initiatives – Enhanced Care Management (ECM) and Community Supports. ECM is a new Medi-Cal benefit that replaces Santa Clara County’s Whole Person Care Pilot (WPC) and SCFHP’s Health Homes Program (HHP). The case management and care coordination services provided through WPC and HHP are expanded under ECM. The housing navigation services provided through WPC and HHP transition to Community Supports and are expanded over time to provide better support for the social needs of members.
Enhanced Care Management
- In alignment with DHCS-designated launch dates, ECM will be offered to members who meet eligibility criteria for one or more of the following populations:
- January 1, 2022: Currently enrolled HHP and WPC members, individuals and families experiencing homelessness, high utilizer adults, and adults with serious mental illness (SMI) and/or substance use disorder (SUD).
- January 1, 2023: Individuals transitioning from incarceration, individuals at risk of institutionalization and are long term care (LTC) eligible, and nursing home residents transitioning to the community.
- July 1, 2023: All other children and youth populations.
- Members who are eligible for ECM will receive a letter from SCFHP explaining ECM and how to enroll.
- Members enrolled in ECM will continue to see their same doctors, but will have an added layer of support with an ECM lead care manager.
- To make a referral, visit www.scfhp.com/ecm to download an ECM Referral Form. The form can be emailed to ECM@scfhp.com or faxed to 1-408-874-1469.
- You may also call the Community Based Case Management Manager for additional information at 1-408-874-1920 or call the ECM general phone number at 1-408-874-1452.
- Members may also contact SCFHP Customer Service at 1-800-260-2055 to see if they are eligible and to enroll.
A provider guide with more details on ECM is available at www.scfhp.com/ecm.
Community Supports
- Community Supports are optional services that SCFHP offers to members as a substitute for other services, such as emergency department visits, inpatient stays, and/or nursing facility stays. Community Supports can be an important part of care for members enrolled in ECM who need additional support in the community.
- There are 14 DHCS-approved Community Supports. SCFHP will offer five of the Community Supports on January 1, 2022 and incrementally offer the additional nine over the next two years.
- Starting on January 1, 2022, SCFHP is offering the following to members:
- Housing Transition Navigation Services
- Housing Deposits
- Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for Elderly and Adult Residential Facilities
- Community Transition Services/Nursing Facility Transition to a Home
- Medically-Supportive Food/Meals/Medically-Tailored Meals
- Community Supports are optional for SCFHP to provide and for members to use. To be eligible, members must meet the criteria for the specific service as defined by DHCS.
- Providers may submit referrals to SCFHP for Community Supports once members are determined as not being eligible for any similar services offered in Santa Clara County. As required by DHCS, SCFHP serves as the payor of last resort for services offered through Community Supports.
- To make a referral, complete and submit a form through the Provider Portal, by secure email to CS@scfhp.com, by fax to 1-408-874-1985, or by phone at 1-408-874-1808.
- For more information on Community Supports, visit www.scfhp.com or call 1-408-874-1929.
- Members may also contact SCFHP Customer Service at 1-800-260-2055 to see if they are eligible and to enroll.
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Preparing for Medi-Cal Rx
Effective January 1, 2022, Medi-Cal pharmacy benefits and services are moving from managed care to fee-for-service (FFS). The pharmacy benefits and services under Medi-Cal FFS are collectively called Medi-Cal Rx. This transition does not affect SCFHP’s Cal MediConnect line of business.
To successfully prepare for this transition, all Medi-Cal providers, including prescribers and their staff, need to register for an account and complete training sessions prior to January 1. Complete the user administration console (UAC) application at https://medi-calrx.dhcs.ca.gov/.
The UAC application is a registration tool that controls and manages each user’s access to the Medi-Cal Rx web portal and associated applications. Providers will need to designate a single point of contact (i.e., delegated administrator) to manage employee access to the secure Medi-Cal Rx web portal.
Medi-Cal Rx web portal features:
- Access the Saba Learning Management System (LMS) for training prior to January 1, 2022
- Explore education and outreach events in the Saba LMS calendar.
- Enroll in web-based instructor-led or computer-based training.
- Access the prior authorization system, chat and messaging features, beneficiary drug look-up tool, and web and batch claims submissions starting on January 1, 2022.
Other resources to prepare for Medi-Cal Rx:
Questions?
For questions or help registering for the Medi-Cal Rx web portal and applications, contact the Medi-Cal Rx Education and Outreach team at MediCalRxEducationOutreach@magellanhealth.com. Please provide the following information in your email:
- Name of individual
- Provider name
- NPI
- Phone number
- Email address
More information
For more information about Medi-Cal Rx, visit https://medi-calrx.dhcs.ca.gov/.
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Excellence in facility site review
Congratulations to Dr. Angela Bymaster, Dr. Cheryl Ho, Dr. Manghnani Rekha, Dr. Daniel Reyes-Villa, VHC Little Orchard, Dr. Julao Charlyne, Dr. Nong Dang (2 sites), Dr. Jose Guanzon, Dr. Teresita Guanzon, Dr. Parveen, Dr. Maggie Chen, Dr. Indira Vemuri, and Asian American Community Involvement- Dr. Poorva Kamath who recently achieved an Exempt Pass on the Department of Health Care Services’ required facility site review (FSR). They each scored above 90% on the FSR without any critical elements, including no infection control or pharmacy deficiencies. Santa Clara Family Health Plan (SCFHP) would like to recognize their outstanding performance and the hard work, thoroughness, and diligence of their staff.
Congratulations to all on a job well done!
Learn more about facility site review requirements.
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Share the news about the SCFHP COVID-19 Vaccination Reward Program
 Santa Clara Family Health Plan (SCFHP) has launched a COVID-19 Vaccination Reward Program to encourage our members to get vaccinated and stop the spread of COVID-19. Eligible SCFHP members can earn a $50 gift card* for receiving their first dose of a COVID-19 vaccine before March 6, 2022.
SCFHP members are eligible for the $50 gift card if they:
- Are a SCFHP member at the time they receive their first COVID-19 vaccine
- Are 12 years old or order time
- They receive the first dose of a COVID-19 vaccine from a California provider between September 1, 2021 and March 6, 2022.
It may take members up to 10 weeks to receive their reward. Providers can help shorten the timeline by submitting or entering their immunization data to the California Immunization Registry (CAIR) as soon as possible. Gift cards will be sent automatically to the member’s address on file once SCFHP receives confirmation from the monthly CAIR Report.
For more details about our reward program, visit www.scfhp.com/covidvax.
*Gift cards cannot be used to purchase alcohol, tobacco or fire arms. Eligibility rules are subject to change.
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Immunization Recommendations & Coverage Details
COVID-19 vaccines:
- Up-to-date recommendations and clinical guidance for the use of COVID-19 vaccines may be found on the CDC website:
- Coverage details:
- Medi-Cal:
- 2021 & 2022: COVID-19 vaccines are covered by Medi-Cal fee-for-service (FFS). Pharmacies or providers should bill Medi-Cal FFS directly.
- Cal MediConnect:
- 2021: COVID-19 vaccines are covered by Medicare FFS. Pharmacies or providers should bill Medicare FFS directly.
- 2022: COVID-19 vaccines will be covered by Santa Clara Family Health Plan (SCFHP). Pharmacies or providers should bill SCFHP directly.
Influenza vaccines:
- 2021-2022 influenza vaccination recommendations may be found in the Morbidity and Mortality Weekly Report (MMWR), which is available on the Centers for Disease Control and Prevention (CDC) website:
- Coverage details:
- The influenza vaccine is covered for Medi-Cal and Cal MediConnect members. Members may go to a participating network pharmacy or see their provider for the influenza vaccine.
Scheduled immunizations:
- Recommended immunization schedules for 2021 in the United States may be found on the CDC website:
- Coverage details:
- Scheduled immunizations are covered for Medi-Cal and Cal MediConnect members. Members may go to a participating network pharmacy or see their provider for scheduled immunizations.
Additional immunization resources:
Pharmacy coverage of vaccinations:
- Medi-Cal:
- Until 12/31/2021:
- Starting 1/1/2022:
- Cal MediConnect:
Billing of in-office administered vaccinations:
- Medi-Cal: Electronic billing is required with the appropriate HCPCS/CPT code.
- Cal MediConnect:
- Part B vaccines: Electronic billing is required with the appropriate HCPCS/CPT code.
- Part D vaccines: You may bill in-office administered Part D vaccines online using TransactRx. For more information, please visit TransactRx’s website at www.TransactRx.com or call 1-866-522-3386.
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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: 793
Cal MediConnect: 523
Specialists
Medi-Cal: 4,824
Cal MediConnect: 3,146
Ancillary
Medi-Cal: 847
Cal MediConnect: 255
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Pharmacies
Medi-Cal: 145
Cal MediConnect: 148
Members
Medi-Cal: 280,666
Cal MediConnect: 10,431
Total: 291,097
As of December 2021
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