NEW Health plan Enrollment Applications

In our ongoing efforts to streamline the enrollment process for all health care providers and department personnel, the UCSF health plan enrollment forms have been modified. The new form was designed to reduce the time needed to complete the forms AND reduce the margin of error by only requiring the provider enter their information once.

What Has NOT Changed:
The basic functionality of the web app's are still the same.
You can still:

- Access current health plan enrollment applications via the web
- Complete them electronically
- Track the enrollment status of each provider on the
UCSF Web Query

What Has Changed:
*Electronic Submission*
This functionality has been added to:

• Complete AND Submit them electronically
  (via Adobe Acrobat or as a Word email attachment)
• Reduce the processing time of provider enrollment by up to a week
• Enable us to procure missing information in a more timely manner
• Allow department/division and Medical Group Credentialing the ability to track submissions from the department using UCSF Outlook
• Create electronic records, so the same information does not need to be completed repeatedly over the course of a providers time at UCSF

While electronic submission is not required, it does expedite the enrollment process.
To complete enrollment for an existing or new provider;

• Complete the questionnaire
• Print all documents out (and/or submit them electronically)
• Have the provider sign the signature pages
• Forward (all pages) with original signatures and attachments via campus mail to box 1821

Attachments are needed for enrollment
For MD's
      Legible photocopies of applicant's
    *      California Professional License
    *      Photo ID (passport, driver’s license)

For Allied Healthcare Professionals
-- Including Medi-Cal signature page of supervising MD --
      Legible photocopies of applicant's
    *      California Professional License
    *      Photo ID (passport, driver’s license)
    *      Masters Degree (NP's)
    *      Supervising MD's California Medical License

The following links have been included for your reference.

MD Health Plan Enrollment

Allied Healthcare Professional Health Plan Enrollment

The UCSF Credentialing Web Query