Commercial provider forms

Find forms and documents for you and your patients below including authorizations and referrals, medical, claim forms, and others you may need to manage your practice and care for your patients.

Select a category from the list below to view and download the forms you need.

Authorizations and referrals

Request prior authorization for behavioral health services
Use this form to submit a prior authorization request for any mental health or substance use disorder services.

English (PDF)

Request precertification for a Point of Service (POS) member
Use this form to request pre-certification for a Sharp Health Plan POS member to receive health services from an out-of-network provider.
English (PDF)

Request prior authorization for prescriptions or step therapy exception
Use this form to submit a prior authorization request for medications or step therapy.
English (PDF)

Request prior authorization for medical services
If a service requires prior authorization, use this form to submit a request to receive approval before scheduling a procedure. Providers who are rendering care to members assigned to a plan medical group (PMG) should contact the PMG for prior authorization.
English (PDF)

Care management

Refer to case management or disease management
Use this form to refer a member to a case management or disease management program.

English (PDF)

Claims and payments

Enroll in electronic data interchange (EDI) for claims submission
Use this form to submit a request to enroll in electronic data interchange (EDI) for claims submission and electronic remittance advice (ERA) in place of paper evidence of benefits (EOBs) and checks.
Online form | English (PDF)

Request reimbursement for medical services
This form is for members who wish to request a refund form Sharp Health Plan for the cost of approved medical services. This form must be submitted directly by the member.
English (PDF)

Request reimbursement for at-home COVID tests
Members can submit FDA approved at-home over-the-counter COVID-19 diagnostic tests for reimbursement beginning January 15, 2022.
English (PDF)

Dispute a payment or denial
Use this form to dispute any payments or denials that have been processed by Sharp Health Plan.
English (PDF)

Grievances and appeals

File a grievance or an appeal
Members can use this form to file a grievance or appeal with Sharp Health Plan or a plan provider.
Online form | English (PDF) | Spanish (PDF)

File a grievance for cancellation of coverage
Members can use this form to file a grievance regarding the cancellation, rescission, or nonrenewal of their health care coverage to the Department of Managed Health Care (DMHC).
Online form | English (PDF)

Member management

Request to reassign a member to a new primary care physician
Use this form to assign your patients to a new primary care physician in your own plan medical group.
Online form

Request to dismiss a member from plan medical group
This form is to be used by a Plan Provider’s office to request dismissal of a current member assigned under a Sharp Health Plan policy.
Online form

Provider information

Update my profile information
Log in to your Sharp Connect account to update your provider profile information such as your status, email, and office locations.
Online form

Visit our Medicare website

Commercial provider forms

Find all the documents you need at the moment you need them with this handy library of forms and resources.

Looking for Medicare provider forms?

Quick Links

Follow and review us