San Francisco Mental Health Plan Provider Manual

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TABLE OF CONTENTS


  1. WELCOME FROM THE DIRECTOR and MEDICAL DIRECTOR
  2. HOW TO USE THIS MANUAL
  3. QUICK REFERENCE PHONE NUMBERS
  4. SAN FRANCISCO MENTAL HEALTH PLAN MISSION, SYSTEM GOAL, VALUES
  5. THE SAN FRANCISCO MENTAL HEALTH PLAN
  6. HOW TO OBTAIN AUTHORIZATION FOR MENTAL HEALTH SERVICES
  7. MEMBER SERVICES
  8. PROVIDER NETWORK REQUIREMENTS
  9. PROVIDER PROBLEM RESOLUTION AND APPEALS
  10. CLAIMS PROCESSING AND PAYMENT
  11. COORDINATION WITH HEALTH PLAN, PRIMARY CARE PROVIDERS, AND OTHER SOCIAL SERVICES
  12. LEGAL REQUIREMENTS
  13. SFMHP QUALITY MANAGEMENT PROGRAM
  14. APPENDICES
    1. Medical Necessity Criteria
    2. Standard Rate Schedule for Participating Providers (Not yet available)
    3. San Francisco Mental Health Plan Access Clinics
    4. Reauthorization Process for Organizational Providers
    5. 24 Hour Adult Services Authorization Form
    6. 24 Hour Geriatric Services Authorization Form
    7. List of Pharmaceuticals Carved-Out from Medi-Cal Health Plans (Not yet available)
    8. SFMHP Consumer Complaint and Grievance Resolution Procedure
    9. Provider Network Requirements
    10. HCFA 1500 Form and Directions
    11. Claims Review Request (CRR) Form (Not yet available)
    12. SFMHP Policy for Confidentiality and Release of Information (Not yet available)
    13. SFMHP Policy for Consent (Not yet available)
    14. SFMHP Policies for Reporting of Child and Elder Abuse (Not yet available)
    15. SFMHP Duty to Warn Policy
    16. SFMHP Policy for Quality of Care Reporting (Not yet available)
    17. SFMHP Inpatient Psychiatric Utilization Review/Payment Authorization Plan (Not yet available)