SFHP approves, ModivCare runs the network.
Since December 1, 2024, ModivCare has overseen San Francisco Health Plan’s network of transportation vendors. SFHP still reviews NEMT itself, and publishes unusually specific rules for discharges and drop-offs.
From San Francisco Health Plan’s own documents, checked on . Not legal or billing advice.
At a glance
- Arranges rides
- ModivCare, since December 1, 2024
- Providers book
- ModivCare’s TripCare portal or Facility Line
- NEMT approval
- SFHP, at least five business days before the visit
- Drop-off
- At least 15 minutes before the appointment
- PCS
- SFHP’s combined request and PCS form; up to 12 months
Who does what
SFHP announced that starting December 1, 2024, ModivCare would oversee a network of transportation vendors for its members. Medical offices book through ModivCare’s TripCare portal or its Facility Line. Members assigned to certain medical groups (SFHP names NEM, NMS, JAD and AMG) request transportation from their medical group instead.
SFHP reviews NEMT itself: it must review and approve NEMT at least five business days before the member’s visit, and decides on a request within five business days. Its 2026 provider manual asks for NMT to be arranged at least ten business days before; the two documents give different numbers, so check with SFHP for the trip type at hand.
Discharges and the three-hour rule
For discharges, ModivCare’s transportation provider has up to three hours from the request to pick up the member. If the estimate is longer than three hours (one hour from an emergency room), the trip may go to the hospital’s contracted provider and ModivCare covers the cost. When another provider is already on site, even one outside ModivCare’s network, the hospital gives it a new trip number so it can bill ModivCare directly.
Drop-offs and the PCS form
SFHP’s rule for drivers is plain: members must be dropped off at least 15 minutes before their scheduled appointment. That is a hard edge for planning appointment-first pickups.
SFHP uses a combined authorization request and PCS form, faxed to SFHP. Authorizations last at most 12 months and must be renewed every year.
Not in the plan’s published documents
We couldn’t confirm these from SFHP’s own pages, so ask the plan or its vendor:
- How a transportation company joins ModivCare’s vendor network for SFHP members.
- An official statement of the service area (San Francisco County is assumed, not quoted).
Running SFHP trips in MileCall
Trips are booked appointment-first, so the pickup is worked back from the time the rider must be there; the rules check pickup windows and ride time before a trip is assigned, and late-risk alerts flag a run that is drifting.
A discharge with a new trip number is just another leg for the ModivCare payer, with its own trip sheet row.
MileCall isn’t connected to SFHP or its vendor; trips come in as files you upload.
See billingSources
Checked on . Rules change: check the current version with the payer before you bill.
Other Medi-Cal plans
How the rest compare, and the rules every plan shares, are on NEMT in California.
L.A. Care Health Plan
Call the Car is the NEMT and NMT vendor; L.A. Care reviews the PCS form.Inland Empire Health Plan (IEHP)
NEMT managed by IEHP since May 12, 2026; Call the Car keeps NMT. Five days’ notice.Health Net (Medi-Cal)
ModivCare schedules NEMT and NMT; Health Net’s Care Ride Unit approves the PCS first.Anthem Blue Cross (Medi-Cal)
ModivCare takes reservations, contracts providers and pays claims. Five business days’ notice.Partnership HealthPlan of California
No broker: Partnership’s Transportation Services coordinates rides. TAR plus PCS for NEMT.Health Plan of San Joaquin
Box-by-box CMS-1500 rules for NEMT claims and a 365-day filing limit.
See your SFHP trips in MileCall.
Bring a day of trips and the trip file you get today. We’ll map it in front of you, plan and dispatch the day, and show what billing holds and why.