Health Plan Enrollment

The Health Plan Enrollment team/department supports the medical staff and the organization/facility by managing and overseeing the processes of ensuring that all UCSF billing providers, including clinical affiliates (approximately 2500), are appropriately and accurately credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal and Tricare which is required to appropriately generate revenue (approximately $500 million annually) in the course of patient care.  

The Health Plan Enrollment team/department ensures that each billing provider is qualified to provide health care services in accordance with UCSF policies and procedures, The Joint Commission and NCQA standards, commercial contracted agreements, as well as State and Federal laws and regulations including the Affordable Care Act. The Health Plan Enrollment team/department serves as the Delegated Official for the University and as such is held accountable to federal and state officials.  

The Health Plan Enrollment team/department is responsible for ensuring the accuracy of all information that is provided on each provider application for health plan enrollment. The Health Plan Enrollment team/department is also responsible for ensuring that all components of contracted health plan credentialing delegation agreements are in compliance.  Failure of compliance may forfeit our established delegation agreements/payer contracts and/or delay reimbursements or payments of claims.