Navigating claims

Simplify the claims process with these tools and resources.

Check eligibility, claims and referrals

View your patients' eligibility information with the Authorization Claims Enrollment System (ACES), including effective date, primary care physician history and copayments, as well as check the status of referrals or claims at any time.


Get paid faster

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.


Sign up for ACES

With the Authorization Claims Enrollment System (ACES), you and your staff can check eligibility, referrals, claims and other member-specific information in a quick and easier way. Find out how to create an account with Sharp Health Plan.


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.


Claims submission and payments

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


Settling claims and disputes

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


Stay on top of the latest news from Sharp Health Plan

See our dispute resolution policy

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


Process of internal audits

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


Upgraded claims auditing system

The auditing guidelines in the field of health care are becoming more complex. And to make sure we are in regulation, we’ve added a few more fields and code combinations to review. Find out what our auditing system looks like as of March 2015.


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.


FBT: no longer supports this Internet browser. For the best experience on our website, please upgrade your browser to the latest version.