SECTION 4 1 CCHP PROVIDER NETWORK
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1 SECTION 4 1 CCHP PROVIDER NETWORK Physicians: Chinese Community Health Care Association (CCHCA) 1 Mid-level Practitioner s Services 1 Participating Providers and Pharmacies 1 Affiliated Hospitals 2 Chinese Hospital 2 Outpatient Services 3 Outpatient Laboratory Services 3 Radiology and Imaging Services 3 Mammography and Bone Density Scan Providers 3 Other Health Care Providers 4 Outpatient Services Providers List Grant Avenue, Suite 700, San Francisco, CA (Tel):
2 Physicians: Chinese Community Health Care Association (CCHCA) Chinese Community Health Plan partners with one medical group -- Chinese Community Health Care Association (CCHCA) medical group. CCHCA has a network of over 280 physicians available to provide care to CCHP members. CCHCA primary care and specialist physicians have offices throughout San Francisco and northern San Mateo County. In addition to physicians, the CCHP/CCHCA network includes many allied health providers, facilities and hospitals. Each CCHP member selects a primary care physician (PCP) from the CCHCA panel. The primary care physician coordinates all care provided to the CCHP member, including referrals to specialists and arrangements for medically necessary hospitalizations. Mid-level Practitioner s Services Physicians who employ mid-level practitioners such as nurse practitioners, physician assistants, or those who have licensed providers like physical therapists, optometrists, etc., must adhere to the following requirements: All mid-level practitioners and/or licensed providers rendering care to CCHP patients must be credentialed. Services provided by mid-level practitioners or licensed providers must be billed using their individual National Provider Identifier (NPI) number. Only services provided by a CCHCA/CCHP physician can be billed under the physician s name and NPI. The credentialing process includes a request for the names and license numbers of health professionals employed by CCHCA/CCHP physicians. To ensure CCHCA/CCHP is compliant in this area, please make sure that all health professionals in your office have been credentialed. If you are not sure whether all health care practitioners in your office have been credentialed, please contact the CCHP Credentialing Department. Participating Providers and Pharmacies For a directory of CCHP providers, go to You will find provider directories for CCHP s various products Commercial Group and Individual/Family members, Senior Program HMO members and Senior Select Program HMO SNP members. CCHP Group and Individual/Family Provider Directory CCHP Senior Program HMO Provider & Pharmacy Directory CCHP Senior Select Provider & Pharmacy Directory 1
3 Affiliated Hospitals We contract with the following hospitals, including: Chinese Hospital St. Francis Memorial Hospital California Pacific Medical Center St. Mary's Medical Center Seton Medical Center Chinese Hospital Chinese Hospital is CCHP s and CCHCA s hospital partner for our integrated care delivery system. As such, Chinese Hospital is our primary hospital in San Francisco for CCHP members residing in San Francisco or affiliated with San Francisco primary care physicians (PCPs). Seton Medical Center is CCHP s primary hospital in San Mateo County. For services not available at Chinese Hospital, the Utilization Management Department will make a determination as to where necessary services can be provided. Hospital services for obstetric patients will be authorized at California Pacific Medical Center (CPMC) or Seton Medical Center for San Mateo residents. Hospital services for pediatric patients will be authorized at CPMC. Chinese Hospital ( offers a wide range of medical, surgical and diagnostic services. Please utilize the services of Chinese Hospital by referring patients as appropriate for both outpatient and inpatient care. Referral for services at Chinese Hospital does not require prior authorization. Inpatient Care (except for Neurology, extensive Cardiac or Psychiatric) Intensive Care, Medical-Surgical, Telemetry, Surgical Suite and PACU Outpatient Care Same Day Surgery Unit, Endoscopy Suite (except Endoscopy Ultrasound) Outpatient Medical Therapy Center (Infusion) 24-hour Treatment Center with Board Certified ER Physicians Diagnostic and Interventional Radiology Services Ultrasound, CAT Scan, Mammography, Dual Energy -ray Absorptiometry (DEA) Scan Cardiac Diagnostic Testing (Non-interventional) Laboratory / Pathology Services (Outpatient and Inpatient) Inpatient Dialysis Nuclear Medicine Nutritional Counseling and Health Education Ophthalmologic Laser Services Pharmacy 2
4 Outpatient Services Providers CCHP and CCHCA contract with several outpatient facilities. Please refer members to the facilities indicated on the Outpatient Services Providers list in this section. Outpatient Laboratory Services Laboratory services must be performed at a CCHP/CCHCA preferred facility. Complete a laboratory requisition and direct the member to a CCHP/CCHCA preferred laboratorydrawing site. (See Outpatient Services Providers list in this section.) Radiology and Imaging Services Routine radiology films do not require prior authorization at CCHP/CCHCA preferred facilities. Prior authorization is required for many radiology and imaging procedures, except for services at Chinese Hospital. Outpatient services at Chinese Hospital do not require prior authorization, except elective epidural injections for pain management. (See Outpatient Services Providers list in this section.) It is the responsibility of the imaging service provider to: 1) Verify member eligibility prior to rendering services 2) Confirm authorization has been approved for services that prior authorization. Mammography and Bone Density Scan Providers San Francisco County CCHP s and CCHCA s preferred providers for mammography services and bone density scans in San Francisco are Chinese Hospital on Jackson Street and RadNet on California Street. Please refer CCHP members to these facilities. San Mateo County In San Mateo County, CCHCA/CCHP doctors may refer CCHP Commercial and Senior Program (HMO) Members for mammograms and bone density screenings to Seton Medical Center in Daly City, RadNet in Redwood City or to one of our preferred facilities in San Francisco. CCHP Senior Select (HMO SNP) members may only be referred to preferred facilities in San Francisco. Prior authorization is NOT required at these CCHP/CCHCA San Francisco and San Mateo County facilities for mammograms (1 per year in accordance with USPSTF 3
5 Recommendations) and bone density scans. Mammograms beyond 1 per year require prior authorization. All other facilities require prior authorization. Prior authorization for services at other facilities will only be approved when medically necessary. Patient preference or the fact that a patient previously received mammography or bone density services from a non-preferred facility does not constitute medical necessity and will not be authorized by the Utilization Management Department. Other Health Care Providers In addition to the participating providers previously listed in this section, the CCHP/CCHCA provider network includes providers of DME, Home Health, Skilled Nursing, Medical Supplies, Transportation, etc. All of these services require prior authorization. When you submit a Service Authorization Request, the Utilization Management Department will direct you to a contracted provider. 4
6 Preferred Outpatient Facilities List Chinese Community Health Care Association 445 Grant Avenue, Suite 700 San Francisco, CA (415)
7 PREFERRED FACILITIES FOR OUTPATIENT SERVICES San Francisco County Please refer patients to facilities marked with an for applicable services. Prior authorization is required for many radiology and imaging procedures, except for services at Chinese Hospital. Outpatient services at Chinese Hospital do not require prior authorization, except elective epidural injections for pain management. Routine -Rays (plain films) and Mammograms (1 per year) at the facilities with an below do not require prior authorization. FACILITY Radiology Mammography Ultrasound Bone Density CAT Scan PET Scan MRI Endoscopy Colonoscopy Fluroscopy Chinese Hospital 845 Jackson St. San Francisco, CA (415) (Except, no endoscopic ultrasound) Health Diagnostics 325 Sacramento Street San Francisco, (415) FA: (415) Insight Imaging 1180 Post St. San Francisco, CA (415) FA: (415) RadNet 3440 California St. San Francisco, CA (415) FA: (415) CPMC CA Campus (For Pediatrics and OB Only) 3700 California St. San Francisco, CA (415) Health Diagnostics Daly City, CA See Page 8 Peds & OB Only Peds & OB Only 6
8 Laboratory San Francisco County Address Phone Number Chinese Hospital Excelsior Health Services Sunset Health Services LabCorp These are some of the facilities located in San Francisco. For more locations, visit Jackson St. San Francisco, CA Paris Street San Francisco, CA st Avenue San Francisco, CA Post Street, Suite 419 San Francisco, CA Sutter Street, Suite 102 San Francisco, CA (415) (415) FA (415) (415) FA (415) (415) FA (415) (415) FA (415) (415) FA 595 Buckingham Way, Suite 222 San Francisco, (415) (415) FA Quest Diagnostics/Unilab Office pick-up is available. These are some of the facilities located in San Francisco. For more locations, visit St. Mary s Hospital (Blood Draw Only) CPMC California Campus (For Pediatrics and OB Only) 490 Post Street, Suite 914 San Francisco, Post Street San Francisco, Parnassus Avenue, Suite 201 San Francisco, CA Clay Street San Francisco, CA Stanyan Street San Francisco, California Street San Francisco, CA (415) (415) FA (415) (415) FA (415) (415) FA (415) (415) FA (415) (415) FA (415) (415) FA Physical Therapy San Francisco Address Phone Number Chinatown Physical Therapy & Rehab Center 728 Pacific Avenue, Suite 301 San Francisco, James Simpson, RPT, Inc Sutter Street, Suite 1003 San Francisco, Ocean Avenue, Suite 103 San Francisco, Wong & Bronstein Physical Therapy 818 Jackson Street, Suite 201 San Francisco, (415) (415) FA (415) (415) FA (415) (415) FA (415) (415) FA 7
9 PREFERRED FACILITIES FOR OUTPATIENT SERVICES San Mateo County Please refer patients to facilities marked with an for applicable services. Prior authorization is required for many radiology and imaging procedures. Refer to the CCHCA Physician Handbook for services requiring prior authorization. Routine -Rays (plain films) and Mammograms (1 per year) at the facilities indicated with an below do not require prior authorization. FACILITY Radiology Mammography Ultrasound Bone Density CAT Scan PET Scan MRI Fluroscopy Health Diagnostics 455 Hickey Blvd., # 200 (650) FA: (650) Health Diagnostics 1860 El Camino Real, # 101 Burlingame, CA (650) FA: (650) Health Diagnostics 345 Convention Way, Suite D-1 Redwood City, CA (650) FA: (650) RadNet 801 Brewster Ave., #100 Redwood City, CA (650) FA: (650) RadNet 35 Baywood Ave., #2 San Mateo, CA (650) FA: (650) Only For Referral of CCHP Commercial and Senior Program Members: Campus Diagnostic Imaging 901 Campus Drive, #113 (650) FA: (650) Only For Referral of CCHP Commercial and Senior Program Members: Seton Medical Center 1900 Sullivan Avenue (650) FA: (650) Seton Coastside 600 Marine Blvd. Moss Beach, CA (650) FA: (650)
10 Laboratory San Mateo County Address Phone Number Daly City Health Services LabCorp STAT services are available at all labs. 93 Skyline Plaza 1440 Southgate Ave., Suite A 1750 El Camino Real, Suite 16 Burlingame, CA (650) (650) FA (650) (650) FA (650) (650) FA Quest Diagnostics/Unilab Office pick-up is available. Seton Medical Center Use only for services not available at labs listed above and only for CCHP Commercial and Senior Program Members. Seton Coastside Use only for services not available at labs listed above and only for CCHP Commercial and Senior Program Members. 101 S. San Mateo Dr., Suite 107 San Mateo, CA Campus Drive Suite # Washington St., Suite N. San Mateo Dr. San Mateo, CA El Camino Real, Suite 101 Burlingame, CA Laurel St., Suite F San Carlos, CA Warren Redwood City, CA Sullivan Ave. 600 Marine Blvd. Moss Beach, CA (650) (650) FA (650) (650) FA (650) (650) FA (650) (650) FA (650) (650) FA (650) (650) FA (650) (650) FA (650) (650) FA (650) (650) FA Physical Therapy San Mateo County Address Phone Number Peninsula Sports Medicine and 2945 Junipero Serra Blvd. (650) Rehabilitation Center Daly City, CA (650) FA Pillars Physical Therapy and Wellness Center Seton Coastside Use only for CCHP Commercial and Senior Program Members th Street, Suite D, 2 nd Floor 600 Marin Blvd Moss Beach, CA (650) (650) FA (650) (650) FA 9
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