How to Provide NEMT Rides for Santa Clara Family Health Plan in 2027

Santa Clara Family Health Plan (SCFHP) is the local Medi-Cal plan for Santa Clara County, working with the county’s providers since 1997. Its board meets as the Santa Clara County Health Authority. Besides Medi-Cal, it runs SCFHP DualConnect, a dual special needs plan for members who have both Medicare and Medi-Cal.

The plan runs its own ride benefit. Members ask SCFHP for a ride, SCFHP approves and books it, and a transportation vendor under contract with the plan drives it. There is no broker in between, so your contract, your credentialing, and your claims all go to SCFHP. For how a plan contract differs from broker work, see contracting with Medicaid health plans.

How big the plan’s ride program is

SCFHP is by far the largest Medi-Cal plan in its county. In August 2026, the state counted 279,599 SCFHP Medi-Cal members in Santa Clara County, against 61,905 in Anthem Blue Cross and 51,326 in Kaiser Permanente. Anthem’s Medi-Cal rides go through Modivcare, not SCFHP (see Anthem Blue Cross Medi-Cal), so each plan is a separate door.

The plan’s transportation manager reported the 2025 numbers to its member advisory groups in March 2026:

• Rides. Nearly 500,000 rides in 2025, between 33,000 and 46,000 a month, with volume rising toward the end of the year.
• Online requests. More than 4,000 ride requests came through the mySCFHP member portal.
• The network. Based on member feedback, the plan said it is improving communication, reducing delays, and expanding its transportation provider network.

Transportation concerns rose slightly with the volume late in the year, the manager said. Earlier, in the third quarter of 2025, transportation delays were among the top Medi-Cal complaint types and transportation complaints rose 22 percent, the plan’s quality committee heard on November 10, 2025. See improving on-time performance.

How members book rides and what reaches your company

SCFHP covers two kinds of rides. Non-emergency medical transportation (NEMT) goes by ambulance, litter or gurney van, wheelchair van, or air. Non-medical transportation (NMT) goes by car, taxi, bus, or other public or private vehicle. See NEMT vs NMT.

Medi-Cal members call Customer Service at 1-800-260-2055 (TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m. DualConnect members call 1-877-723-4795 (TTY 711), seven days a week, 8 a.m. to 8 p.m. Both can also ask on the mySCFHP portal or app. These are the rules in the plan’s 2026 handbooks and its transportation page:

1. Notice. At least five business days for a routine NEMT ride and three business days for NMT. Members can ask up to a month ahead on the portal, and should call as soon as possible for an urgent visit.
2. Online requests. Staff review them within three business days and confirm by email, the plan told its Consumer Advisory Committee on March 3, 2026.
3. Pickup. The ride is scheduled to arrive up to 60 minutes before the appointment, and members are told to be ready and waiting at that time.
4. Service level. NEMT is door to door: when needed, the driver helps the member from the door to the vehicle and from the vehicle into the facility, and may carry limited belongings or medical equipment for the trip. NMT is usually curb to curb, may be shared with another rider, and drivers do not carry the member’s items.
5. Riders. One companion or personal care attendant may ride along when the member says so while booking.
6. Requests the plan cannot honor. Preferred drivers or vehicle models.
7. The trip home. All new requests must go through Customer Service or the portal, but once a ride is scheduled with a provider, the member may call that provider for the return trip (Consumer Advisory Board, March 5, 2026). Plan for will-call trips on every round trip.

A member under 18 riding without a parent, guardian, or authorized representative needs the plan’s Transportation of a Minor Consent Form (form 50794E, September 2025). The adult signs it, it lasts one year from the signature date, and it lets SCFHP’s NEMT and NMT providers carry the minor to approved appointments. Ask whether one is on file before a minor rides alone, and see children in NEMT.

The PCS form and prior authorization

Every NEMT ride needs the plan’s approval first. The 2025 provider manual makes two exceptions: a transfer from an acute inpatient hospital to a skilled nursing facility or intermediate care facility, and a transfer from one of those facilities to an acute care hospital. For discharge work, see hospital discharge transportation.

The approval rests on the plan’s Physician Certification Statement (PCS) form, form 40809. It asks for:

• The mode. Ambulance, litter or gurney van, wheelchair van, or air transport. More than one can be requested.
• The reason. For a wheelchair van, the boxes include needing a wheelchair or help between home, vehicle, and treatment, severe mental confusion, paraplegia, dialysis, and oxygen without monitoring. For a gurney van, they include lying flat, a post-surgery member who cannot sit up for the trip, bed bound, and a spica cast.
• The diagnosis. It must support the need, with ICD-10 codes.
• Functional limits. A required written description of why the member cannot walk with help or ride a public or private vehicle.
• Dates. One time only, or ongoing for up to 12 months.
• The signer. The member’s physician, dentist, podiatrist, or mental health or substance use disorder provider, with an NPI, certifying that medical necessity decided the type of ride.

The office faxes the form to Utilization Management at 1-408-874-1957 (phone 1-408-874-1821). The 2026 member handbook adds physical, speech, and occupational therapists, physician assistants, nurse practitioners, and certified nurse midwives to the providers members can ask. An approval lasts up to 12 months and covers as many rides as the member needs to covered medical and pharmacy visits. NMT needs no PCS form; the member attests to having no other way to get there.

The plan pays for the lowest cost ride that meets the member’s needs, to the closest provider from the member’s home where an appointment is available. Rides outside its network or service area need approval first. Its Transportation Services policy (UM.13 v4, in the December 18, 2025 board packet) promises door-to-door help for every NEMT member.

Visits that Medi-Cal pays outside the plan, such as specialty mental health, substance use disorder treatment, and dental care, follow a split rule. All Plan Letter 22-008 makes the plan provide NMT to them. For NEMT to those visits, the 2026 Medi-Cal handbook says SCFHP does not cover the ride and instead helps the member schedule it with Medi-Cal, so do not bill the plan for that wheelchair or gurney trip. NEMT to Medi-Cal pharmacy visits stays with the plan.

How to become a Santa Clara Family Health Plan transportation vendor

The plan’s vendor oversight policy (PN.08 v2, reviewed by its Executive and Finance Committee on February 26, 2026) puts Provider Network Operations in charge of contracting with transportation vendors and credentialing them, including checking registration in PAVE, the Medi-Cal enrollment system. Follow this order:

1. Enroll in Medi-Cal. All Plan Letter 22-008 (May 18, 2022) requires every NEMT and NMT company in a Medi-Cal plan’s network to meet Medi-Cal enrollment rules. A plan may let you drive for up to 120 days while your application is pending, and must end the contract if DHCS denies you or the 120 days run out. The California guide walks through PAVE.
2. Send a Letter of Interest. The plan’s Become a Provider page (updated April 25, 2025) asks new providers to fill one out, and the plan contacts you after it reviews the letter. The Letter of Interest on the plan’s provider forms page (form 40845) asks for your business name, tax ID, NPI, Medi-Cal and Medicare provider numbers, whether you have ever been sanctioned by Medicare, Medicaid, or another government program, and the type of provider you would be, with ancillary among the choices.
3. Plan to bill electronically. Form 40845 says SCFHP requires every contracted provider to bill electronically, so set up a clearinghouse account before your first ride.
4. Ask what the plan needs. Call Provider Network Operations at 1-408-874-1788 or email ProviderServices@scfhp.com about the parts of the county, hours, and vehicle types it is short on. The plan said in March 2026 that it is expanding its transportation network.

Keep your file current with the NEMT credentialing checklist.

How the plan oversees its vendors

Under policy PN.08, SCFHP reviews each vendor’s performance at Joint Operating Committee meetings, and an internal workgroup meets regularly on transportation needs. When a vendor falls short, the plan may increase monitoring, place it on a corrective action plan, stop booking new rides with it, or end its contract. Transportation grievances go into the reports its Quality Improvement Committee reviews.

The plan’s compliance reports show what that oversight looks like:

• Wait time billing. In the third quarter of 2025, the plan recovered $880,000 from its fraud, waste, and abuse investigations, a partial refund from a transportation provider that billed for wait times that did not occur. The provider is repaying in monthly installments (Compliance Committee, November 19, 2025). Medi-Cal pays waiting time under T2007, so keep records that show every billed half hour.
• The settlement. Recoveries in the fourth quarter of 2025 totaled $240,000, mostly from an ongoing transportation billing settlement that staff said would continue through June 2026 (Compliance Committee, February 26, 2026).
• Kickbacks. At the same meeting, staff described an investigation, still open in February 2026, of possible kickbacks between transportation drivers and members riding to a methadone clinic. The plan notified its transportation providers, required neutral dispatching, and suspended five drivers, and it declined a vendor’s request to reinstate two of them while the investigation continues. See anti-kickback rules for NEMT.

How the plan pays transportation claims

Your rate comes from your SCFHP contract. The Medi-Cal fee-for-service maximums are the benchmark to compare it with. Medi-Cal’s ground transportation rate page, last updated September 2023 and still the current page in October 2026, lists $20.30 for a wheelchair van pickup (A0130), $26.43 at night, $26.29 for a litter van pickup (T2005), $32.42 at night, $1.50 a mile, and $11.30 for each half hour of waiting.

The plan’s 2025 provider manual, updated March 3, 2025, sets the billing rules:

• Format. Electronic claims on the 837 professional format, through Change Healthcare, Office Ally, or your own clearinghouse, with payer ID 24077. Paper CMS-1500 claims are only for claims that cannot go electronically, and the plan takes no claims by fax or email.
• Time limits. Send original claims within six months of the ride. Late claims without an accepted delay reason may be paid at a reduced rate, or denied once 365 days have passed since the date of service. See timely filing limits.
• Disputes. Dispute a Medi-Cal claim result within 365 calendar days of the remittance advice, or a DualConnect result within 120 calendar days. The plan answers Medi-Cal disputes within 62 calendar days or 45 working days.
• Corrected paper claims. Stamp them “CORRECTED CLAIM” and mail them with the remittance advice to the Claims Department, Santa Clara Family Health Plan, PO Box 18640, San Jose, CA 95158.

Changes ahead

From January 1, 2027, some members get Medi-Cal through fee-for-service instead of a health plan: undocumented members, some green card holders in the five-year waiting period, and members considered PRUCOL, the plan’s Medi-Cal changes page says. Their rides will no longer come through SCFHP. With your PAVE enrollment you can keep serving them by billing fee-for-service Medi-Cal, and its rate page says wheelchair and litter van rides there need a treatment authorization request (TAR). The California guide explains fee-for-service billing.

The plan is also preparing to merge with Valley Health Plan, which already serves some SCFHP members as a delegated plan, into one plan under the county. Staff reported state filings and joint work groups to its committees between December 2025 and February 2026, with no merger date set. Ask Provider Network Operations how the merger could affect vendor contracts before you sign.

Who to contact at Santa Clara Family Health Plan

For	Contact
Medi-Cal member rides	1-800-260-2055 (TTY 711), weekdays 8:30 a.m. to 5 p.m.
DualConnect member rides	1-877-723-4795 (TTY 711), daily 8 a.m. to 8 p.m.
PCS forms and NEMT authorizations	Utilization Management, fax 1-408-874-1957, phone 1-408-874-1821
Contracting and the Letter of Interest	Provider Network Operations, 1-408-874-1788, ProviderServices@scfhp.com
Minor consent forms	Fax 1-408-874-1965, or Customer Service, PO Box 18880, San José, CA 95128
Reporting fraud	Compliance hotline 1-408-874-1450, ReportFraud@scfhp.com

Before you call about a contract, have your PAVE approval or application number, NPI, tax ID, insurance certificates, vehicle list by type, and the hours and parts of the county you can cover ready. Other California plans that run their own rides, such as IEHP and Partnership HealthPlan, each need their own contract.