Nature of Contract
- On-site eligibility workers screen all referred unsponsored medical Acute admissions by San Francisco General Hospital Eligibility Staff and all acute Psych admissions for Medi-Cal and other federal, state and local health care programs.
- Secure authorization to represent the patient and complete Medi-Cal applications and/or any other new federal, state, and local programs, i.e. those under the Affordable Care Act. Including the referrals for undocumented Aliens.
- Represent the patient in Fair Hearings or all other State or legal appeals proceedings, if applications are denied.
- Appeal Medi-Cal Field office or other Pre-Treatment Authorization program denials for care.
- Investigate possible third party liability or Workers Compensation reimbursement. File liens to protect the City and County’s interest whenever appropriate or possible.
Date Contract Approved
September 19, 2014