Sanfranciscohealthplan Prior Authorization Lookup
Latest Sanfranciscohealthplan prior authorization updates5
- Prior AuthAdministrative/Operational PolicyEff. 2025-12-18Prior AuthorizationDefines SFHP's prior authorization processes, requirements, submission and monitoring procedures for providers and delegated groups across SFHP managed care lines of business.All sanfranciscohealthplan updates
- Prior AuthClinical/Medical PolicyEff. 2018-05-177-Day Limit on Initial Short-Acting Opioid PrescriptionsSFHP limits the first prescription for short-acting opioid medications for acute pain to a seven-day supply for members with no paid opioid claims in the prior 180 days; exemptions and prior authorization processes are specified and affect prescribers and certain patient groups.All sanfranciscohealthplan updates
- Prior AuthClinical/Medical PolicyAbaloparatide (Tymlos) — Prior Authorization and Coverage CriteriaDefines prior authorization and coverage restrictions for abaloparatide (TYMLOS) for San Francisco Health Plan members, including a 24-month cumulative parathyroid-class treatment limit, prescriber and documentation requirements where specified, and typical authorization durations.All sanfranciscohealthplan updates
- Prior AuthAbortion ServicesThis policy governs SFHP coverage and procedures for abortion services (outpatient and inpatient), including medical abortion with mifepristone, for SFHP members across specified lines of business. It explains prior authorization rules, consent, and provider obligations.All sanfranciscohealthplan updates
- Prior AuthAdministrative/Operational PolicyPersonnel Training: Prior Authorization / ReferralsGoverns procedures and expectations for clinic/site personnel to process and track internal and external referrals, ensure receipt of specialist/procedure reports, and maintain referral documentation for Primary Care Physician (PCP) sites affiliated with San Francisco Health Plan.All sanfranciscohealthplan updates
Tool Description
Search Sanfranciscohealthplanprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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