Copy
A newsletter for SCFHP's providers
Vol. 5, Issue 1  January 2021 
In this issue

New PCP auto-assignment algorithm

In December, we released a provider memo outlining changes to the PCP auto-assignment algorithm for new members who do not select a PCP. As noted in the memo and effective January 1, SCFHP will be using the final Provider Performance Program (PPP) percentage each year to determine a quality score that will be integrated in the auto-assignment algorithm. A higher PPP percentage is an opportunity to get additional new members auto-assigned to you throughout the year. For more information, see the memo. If you have questions, please contact Provider Services at ProviderServices@scfhp.com.

2021 updates to the Provider Performance Program

We are pleased to announce that we will continue to offer the Provider Performance Program (PPP) in 2021. To keep our HEDIS measures aligned with NCQA, we will be removing five measures and adding three new measures (see below). All other program measures and resources will remain the same. We look forward to working with all of you in 2021 to support quality care. If you have any questions about the PPP, please reach out to our Program Managers at ProviderPerformance@scfhp.com.
Removed measures:
  • Adult BMI Assessment (ABA)
  • Adolescent Well-Care Visits (AWC)
  • Well-Child Visits in the First 15 Months of Life (W15)
  • Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34)
  • Asthma Medication Ratio (AMR)
New measures:
  • Well-Child Visits in the First 30 Months of Life (W30) – two rates
  • Child and Adolescent Well-Care Visits (WCV)
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) – three rates

2021 Cal MediConnect benefits

SCFHP Cal MediConnect offers a wide range of benefits for members who are eligible for both Medi-Cal and Medicare.
 
Popular benefits
  • Long-Term Services and Supports (LTSS)
    • LTSS that occur in the member’s home, community, or in a facility. LTSS include Multipurpose Senior Services Program (MSSP), Community-Based Adult Services (CBAS), and Nursing Facilities (NF).
  • Transportation
    • Unlimited roundtrips for covered medical services, including doctor visits, lab tests, X-rays, and pharmacy visits.
New benefits
  • Acupuncture
    • Up to two outpatient services per month in one calendar year, or more often if medically necessary.
    • Prior authorization may be required for more than two services per month, and for pregnant women or members living in a nursing facility.
    • Cost share: $0
  • Chiropractic services
    • Adjustments of the spine to correct alignment (when accompanied by documented subluxation)
    • Up to two outpatient chiropractic services per month in one calendar year, or more often if medically necessary.
    • Prior authorization may be required for more than two services per month.
    • Cost share: $0
 
Learn more about SCFHP Cal MediConnect benefits in the 2021 Member Handbook.

New year, new habits

With the start of the new year, now is the perfect time to talk about nutrition and physical activity with your patients!

Discussing healthy lifestyle changes with patients when they come in for their annual exam is a great way to encourage better overall health. Plus, reminders like these have a huge impact on setting healthy behaviors all year long.
 
Are you unsure of what to go over during visits? Here’s a checklist:
 
Nutrition
  • Ask about current nutrition behaviors (e.g., eating habits and dieting behavior)
  • Counsel or refer the patient for nutrition education, if necessary
  • Discuss the importance of healthy weight and preventing obesity
  • Provide anticipatory nutrition guidance
Document “counseling of nutrition” in any setting, including telehealth visit, e-visit, or during a face-to-face visit (CPT: 98702, 98703).

Physical activity
  • Ask the patient about their current physical activity behaviors (e.g., exercise routine and participation in sport activities)
  • Counsel or refer the patient for physical activity, if necessary
  • Provide anticipatory guidance specific to your patient’s physical activity
Document “counseling of physical activities” in any setting, including telehealth visit, e-visit, or during a face-to-face visit (ICD10: Z71.82).
Health education
SCFHP offers health education classes on many topics, including nutrition and physical activity. Many of our programs are offered in languages other than English and some programs are being offered virtually. Members can call organizations directly to register—just say they are an SCFHP member. No authorization from SCFHP is required. 

View a list of available health education programs and log into Provider Link (providerportal.scfhp.com) to request health education for your patients.

Schedule appointments for your new patients

Login to Provider Link at providerportal.scfhp.com to download your new patient rosters and current patient rosters. These rosters are updated monthly. Use these rosters to schedule appointments with newly assigned patients. Remember, DHCS requires completion of an initial health assessment (IHA) within 120 calendar days of a member’s enrollment with SCFHP.
 
If your patients are going to a different provider, please ask them to call SCFHP Customer Service and change their PCPs.
 
SCFHP Customer Service
For Medi-Cal members:
1-800-260-2055 (TTY: 711)
Monday-Friday, 8:30 a.m. to 5 p.m.
 
For Cal MediConnect members:
1-877-723-4795 (TTY: 711)
Monday-Friday, 8 a.m. to 8 p.m.

Avoid COVID-19 vaccine scams

As COVID-19 vaccine distribution begins, warn your patients of potential scams. For example, here is a list of red flags:
  • Patients are asked to pay out of pocket to get the vaccine.
  • Patients are asked to pay to put their name on a vaccine waiting list or to get early access.
  • Advertisements for vaccines that are on social media platforms or coming from email, telephone calls, online, or from unsolicited and unknown sources.
  • Marketers are selling or shipping doses of the vaccine for payment.
Remind your patients to protect themselves by not giving out their personal information to unknown sources.
 
Report fraud
If your patients believe they are victims of COVID-19 fraud, immediately report it to the following agencies:
  • U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Hotline: 1-800-HHS-TIPS (1-800-447-8477)
  • Federal Bureau of Investigation (FBI) Hotline: 1-800-CALL-FBI (1-800-225-5324)
  • Centers for Medicare & Medicaid Services (CMS) Hotline: 1-800-MEDICARE (1-800-633-4227)

Office closures

The SCFHP office will be closed on the following date(s):
  • January 18, 2021 in observance of Martin Luther King Jr. Day

Provider Link

Visit providerportal.scfhp.com to download your member roster and report cards, check authorizations and claims status, and check member eligibility.

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.

Memo roundup

We are dedicated to keeping our providers informed about operational and regulatory changes. Below are important memos that were sent recently:
Memo archive

SCFHP by the numbers

Providers (Unique NPI)
Primary care
Medi-Cal: 819
Cal MediConnect: 541
 
Specialists
Medi-Cal: 4,369
Cal MediConnect: 3,091
 
Ancillary
Medi-Cal: 866
Cal MediConnect: 239
Pharmacies
Medi-Cal: 178
Cal MediConnect: 174
 
Members
Medi-Cal: 261,287
Cal MediConnect: 9,820
Total: 271,107
 
As of December 2020
LinkedIn LinkedIn
Call us at 1-408-874-1788 Call us at 1-408-874-1788
Email Email
Copyright © 2021 Santa Clara Family Health Plan, All rights reserved.


Not yet a subscriber? Subscribe here: http://bit.ly/SCFHPeNews_Signup
Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.