Please attach all supporting details and documentation. Supporting documentation may be in the form of copiesof medical records, office notes, etc., and may include pertinent dates, documentation of conversations, billing statements, documentation of previous attempts to educate the member regarding noncompliance with recommended treatment plans or office practices.
Please attach all supporting details and documentation in either word, excel, or pdf format.
Note: Sharp Health Plan may request additional documentation from the plan provider. Requests must be fulfilled within five business days. If requests for additional documentation are not fulfilled within this timeframe, the dismissal request will
Attachments are required to process your request.