For application developers

Developing FHIR^® resources to deliver clear, standardized data formats to registered application, or app, developers.

Sharp Health Plan has created a portal for third-party app developers to access application programming interfaces, known as APIs, documentation and registration services pursuant to the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule,
CMS-9115-F.

OptumHealth Behavioral Solutions of California (Optum Behavioral Health) manages mental health services and substance abuse disorder on behalf of Sharp Health Plan. Pursuant to the Centers for Medicare & Medicaid Services (“CMS”) Interoperability and Patient Access Final Rule (CMS-9115-F), Optum Behavioral Health has published a behavioral health Provider Directory API to allow Third Party Applications to retrieve the applicable Optum Behavioral Health provider directory information.

Sharp’s developer portal

The following is intended for app developers only.

Support

If you have technical questions or concerns, please call Sharp HealthCare’s Technical Assistance Center at 1-858-627-5201.

API documentation

Sharp Health Plan

• Provider Directory API documentation

Retrieve, as applicable, certain provider and pharmacy directory information.

• Patient Access API documentation

Retrieve, as applicable and with the approval of the requesting enrollee or personal representative, certain data concerning adjudicated claims, encounter data from capitated providers, formulary data and certain clinical data, if Sharp Health Plan maintains any such data.

Optum Behavioral Health

• Optum Behavioral Health Interoperability APIs

Retrieve, as applicable, certain Optum Behavioral Health provider directory information.

Machine-readable files

Sharp Health Plan files

Pursuant to CMS regulations under the Transparency in Coverage rule, developers may access Sharp Health Plan’s machine-readable files using the links below.

These files are in JSON format and are updated monthly as required by CMS. Visit our frequently asked questions for more information about Transparency in Coverage.

• Table of Contents
• Allowed Amounts
• In-Network - CAP
• In-Network - FFS
• Provider References

Optum Behavioral Health files

Optum manages mental health and substance use disorder services on behalf of Sharp Health Plan. Pursuant to CMS regulations under the Transparency in Coverage rule, developers may access Optum’s machine readable files using the link below.

These files are in ZIP format, and expanded as JSON format, and are updated monthly.

• Optum Behavioral Health MRFs

Aetna POS files

Meritain Health helps manage benefits, claims, and customer service for Aetna POS plans offered by Sharp Health Plan. Pursuant to CMS regulations under the Transparency and Coverage rule, access is granted to Aetna’s ASA machine-readable files using the link below. To download the required files, you will need to search on the code "ASA_12". These files will be updated monthly.

• Aetna MRFs

First Health PPO files

First Health is a national health benefits company that provides PPO network access on behalf of Sharp Health Plan. Pursuant to CMS regulations under the Transparency in Coverage rule, access is granted to First Health’s machine-readable files using the link below. Files post by the 2nd Tuesday of the month.

• First Health MRFs