Navigating claims

Simplify the claims process with these tools and resources.

Check eligibility, claims and referrals

View your patients' eligibility information with Sharp Connect, including effective date, primary care physician history and copayments, as well as check the status of referrals or claims at any time.

LOG IN TO SHARP CONNECT ➜

Claims payment information

Avoid delays by signing up for direct deposit. By enrolling in the EFT (Electronic Funds Transfer) service, you can get your money in a safer and more convenient way.

EFT INFORMATION ➜

Guide for overpayments and retractions

Our policies and procedures are handy resources that can help guide you through the process of claims overpayments and retractions.

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Claims submission and payments

Browse through our guidelines to better understand our process for submission, acknowledgment and payment for claims.

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Settling claims and disputes

See our practices for claim submission and overpayments, the dispute resolution process, and fee schedules.

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See our dispute resolution policy

Get an overview of the process, documentation and steps we take to resolve provider claims disputes.

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Stay on top of the latest news from Sharp Health Plan

If something doesn’t seem right, tell us about it

Healthcare fraud is serious business. It results in higher premiums and reduced budgets, which can negatively impact the quality of health care. Learn about our efforts and what you can do to help us combat fraud, waste and abuse.

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Process of internal audits

Find useful information about audit criteria, required documentation, and the rules and regulations for ensuring health care compliance.

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Claims negotiation policy

Attention non-contracted providers: here you will find our guidelines for processing claims.

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Medicare organization determination reopenings

Use these guidelines to understand Sharp Health Plan's process for reopening claims. 

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Prior authorization claims & level one guidelines

Use this document to understand Sharp Health Plan's guidelines for processing claims that may require a prior authorization. 

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