Providers — Frequently Asked Questions
If your question is not listed below, please contact our Network Development / Provider Support Department at (619) 228-2330 for assistance, or send an e-mail via our Contact Us Form. We are here to help.
How can I become a contracted provider with Sharp Health Plan?
Physicians interested in participating in our network may contract with Sharp Health Plan independently or through a contracted medical group. Sharp Health Plan requires a physician to go through a credentialing process before becoming a contracted provider.
What is credentialing?
Credentialing is a systematic approach to the collection and verification of a practitioner applicant’s professional qualifications. It considers factors such as relevant training, licensure and certification and/or registration to practice in a health care field. Credentialing requires that a physician:
| • | Be board certified or have satisfactorily completed a residency in his or her practice specialty |
| • | Have a current California medical license |
| • | Have a current, unrestricted Drug Enforcement Agency (DEA) registration number |
| • | Have admitting privileges at a Sharp Health Plan contracted hospital affiliated with his or her physician’s medical group. Exceptions may be made for certain types of physicians who do not normally obtain admitting privileges or if the physician has arrangements with another Sharp Health Plan credentialed physician to admit on his or her behalf. |
| • | Be free of any Medical Board of California restrictions |
| • | Provide 24-hour-a-day coverage for all Plan members with another participating physician or with another on-call physician who agrees to abide by the guidelines of the Plan |
| • | Have professional liability insurance in the minimum amount of $1 million per occurrence and $3 million annual aggregate |
The credentialing process also includes primary source verification of all information on the application; a practice site and medical record-keeping evaluation; and approval by Sharp Health Plan's Peer Review Committee. Credentialing may be performed directly by Sharp HealthCare’s Centralized Credentialing Department or by the contracted medical group.
How do I check patient eligibility?
Sharp Health Plan provides two online options for checking eligibility: SharpConnect and MCA Outreach. Call Network Development / Provider Support at (619) 228-2352 to find out more. For a one time eligibility check, call Customer Care at (619) 228-2490. You can verify eligibility 24 hours a day using a touchtone phone; just select the option to verify eligibility. Providers may also speak directly to a member of the Customer Care team, Monday through Friday, 8 am to 6 pm.
How can I get a listing of Sharp Health Plan patients assigned to me?
Physicians who are contracted directly with Sharp Health Plan may call Network Development / Provider Support at (619) 228-2352 to request a list of their assigned members.
How do I get a provider directory
Sharp Health Plan’s provider directory is available online. To request a paper copy of Sharp Health Plan’s provider directory call Customer Care at (619) 228-2490.
How can I find out the status of my claim?
For services provided to Members assigned to one of the following Plan Medical Groups, providers should contact the group directly:
| • Children’s Physicians Medical Group | (858) 309-6280 |
| • Greater Tri-Cities IPA | (760) 941-7309, option 3 |
| • Primary Care Associates Medical Group | (909) 476-1575 x63007 |
| • Sharp Community Medical Group | (858) 499-2550 |
| • Sharp Rees-Stealy Medical Group | (858) 499-2410 |
Providers who are contracted directly with Sharp Health Plan and providers outside San Diego and southern Riverside counties can call Customer Care at (619) 228-2490 for information regarding claims status.
I can’t locate my Sharp Health Plan provider contract. How can I find out my contract rate of reimbursement?
Physicians who are contracted directly with Sharp Health Plan can call our Network Development / Provider Support Department at (619) 228-2330 with questions about reimbursement, or send an e-mail via our Contact Us Form.
Where can my patients find more information about wellness programs available to Sharp Health Plan members?
Members have direct access to a variety of wellness programs offered through Sharp Health Plan, including online self-management tools, trackers, workshops and telephone-based health coaching. For more information, members can visit us online.
For information, call our Provider Relations Department at (619) 228-2352. We’re here to help!
