Our prior authorization guide makes it easy to determine when prior authorization is required for a particular service. Note that these guidelines are specific to services for members enrolled in an HMO plan and assigned to providers who are independently contracted with us.
Not sure if a member needs a referral, authorization, or notification prior to receiving care? Use this guide to quickly find out whether you need to fill out forms and how to submit them.
If you would like to prescribe a medication that requires authorization, you’ll need to fill out the prior authorization request form and give us any relevant support or documentation. Once the form is complete, we can review your request.
See what mental health and substance use disorder services require prior authorization for our commercial plan members.
We’ve adopted a series of guidelines to help your team improve your patients' health.
Find out the American Academy of Pediatrics’ and American Congress of Obstetrician and Gynecologists’ most recent recommendations on quality care for pregnant women and their babies.
See which vaccines the Advisory Committee for Immunization Practices (ACIP) recommends for members based on their age and other characteristics.
Learn how to help members get access to the services they need for diagnosis and treatment of behavioral health conditions.
Find out how members can access acupuncture or chiropractic services through American Specialty Health.
Get helpful reminders about how to comply with the timely access laws, which outline maximum wait times for telephone calls and appointment requests.
Learn how to help members get covered outpatient prescription drugs from local, Sharp Health Plan-contracted pharmacies.
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