How to Verifiy Member Eligibility
Eligibility for a member must be verified with SFHP and Medi-Cal online or over the phone prior to rendering services. To check eligibility with SFHP and Medi-Cal online, you will need to create an account with each source first. Please see below on the links to create an account as well as a step-by-step on how to utilize each site.
Please create an account with SFHP’s portal. This resource is used to check a member’s health plan eligibility. It shows which medical group the member is in as well as their effective or termination date. The patient’s SFHP ID and basic demographics will also be displayed on this website.
1. Log into the SFHP Provider page
2. Click “Office Management”
3. Click “Eligibility” and you will be brought to the Eligibility Search page
4. Type in member’s information and click “Search.” You will be brought to a list of search results.
Please note you can search by member’s name, SFHP Member ID, or Social Security Number.
5. Click on the member’s name and you will be brought to that member’s demographics with the Benefit Plan Information listed.
Alternatively, you may call SFHP Customer Service at (415) 547-7800 to verify eligibility with SFHP.
Please create an account with Medi-Cal. This resource is used to check which insurance and health plan the patient has (i.e. San Francisco Health plan, Medicare, or other commercial insurances). Checking the patient’s eligibility here requires the member’s CIN# which can be obtained from the patient’s Medi-Cal ID Card.
1. Log into the Medi-Cal Eligibility page
2. Select “Single Subscriber”
3. Type in member’s CIN#, DOB, and issue/service dates, then click “Submit”
4. Member’s health plan eligibility will be listed in the “Eligibility Message” box
Alternatively, you may call the Medi-Cal Eligibility office at (916) 552-9200 to verify eligibility with Medi-Cal.