Providers are the heart of Sharp

Here you'll find the tools and support you need to be there for your patients when they need it most.

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Coronavirus & COVID-19 resources for providers

Stay up-to-date on Sharp Health Plan-related information related to coronavirus and COVID-19.

News and alerts

We serve up the latest Sharp Health Plan news for you so that you can better serve your patients.

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Claims information

Here you can check the status of a claim and find the information and forms you need to make filing and settling claims easy for your patients.

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Utilization management

Here are the guides, manuals and resources you need to request prior authorization, make a referral and access Sharp’s medical policies.

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Are you looking for our medical and pharmacy policies and procedures? They're located on our provider portal.

Prior authorization

Check our prior authorization guidelines for covered procedures, services and medications before you perform a service or prescribe.

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Prescriptions and medications

Search the covered drug and specialty drug lists, download prior authorization request forms, and find pharmacy benefit resources, all in one place.

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Behavioral health services

Learn how to help members get access to the services they need for diagnosis and treatment of behavioral health conditions.

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We’re here to help

With our providers, patients and health plan working together, we can ensure the best possible outcome every time. For eligibility, referrals, claims, credentialing, contracting, assistance with Sharp Connect or any other provider-related matter, please email us at provider.relations@sharp.com or call 1-858-499-8330.


Contact us


Meet our provider relations team


Victor Gonzalez

Victor Gonzalez
Provider relations representative

Victor has worked in the health care HMO industry for the past 17 years, specializing in provider relations. Throughout his career, he has had the great pleasure of working closely with several physicians and their staff. Victor is delighted to be a part of the Sharp Health Plan provider relations team, and looks forward to creating a great working relationship with you.

Shelly Lilly

Shelly Lilly
Provider relations representative

Before joining Sharp Health Plan, Shelly was a case management coordinator at Sharp Grossmont Hospital, where she worked for nine-and-a-half years. At Sharp Grossmont, Shelly helped to develop department processes, worked on the Reward and Recognition Committee and was a 3-time Sharp C.O.R.E. Award team winner. While not a native to San Diego, Shelly is active in her community, serving as a Parent Teacher Student Association board member, Girl Scouts Leader and church council member.

 

Manuals and guides

Here are some useful manuals and guides to help you better manage your Sharp Health Plan patients.

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Commercial provider forms

Browse, download, and print enrollment forms, authorization request, appeal requests, and other useful documents.

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Medicare provider forms

You can find Medicare forms and authorizations on the Sharp Direct Advantage website.

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Timely access to care

Get helpful reminders about how to comply with the timely access laws, which outline maximum wait times for phone calls and appointment requests.

 
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Language assistance program

Quality care depends on clear communication between you and your patients. Get the right support so that no questions are left unanswered.

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Quality improvement

Find the programs in place to help keep your patients safe and the resources available that support quality care.

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Clinical resources

Use our library of clinical resources to save time, diagnose and treat members even more effectively, and make the member experience the best it can be.

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Become a contracted provider

We wouldn't be here without the passion and skill of providers just like you. Enrollment starts here, and we'd love to partner with you.

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Provider with iPad

Important information on the shingles vaccine

National demand for the shingles vaccine, Shingrix, is greater than the current supply. Learn how you can help your patients through the Shingrix shortage.

READ THE UPDATE HERE

"We are thrilled with the support that we receive at all levels. All of the points of contact are professional, committed and passionate about providing high-quality service."

- Sherri R., Director of Benefits & HR Information Systems, Palomar Health