Our mental health & substance use disorder services

Provide members with the support they need to get through tough times.


We provide coverage for the diagnosis and treatment of mental health and substance use disorders for all members, at any age and stage.

Your patients can determine which services are covered by logging in to their Sharp Health Plan online account.

We support and adhere to the California laws regarding mental health parity, maternal mental health and autism spectrum disorder. Please review our mental health guide for more information.

Behavioral health benefits to make life better

We offer a broad range of benefits for San Diegans, including inpatient hospital services, partial hospital services, and outpatient services ordered and performed by participating mental health and substance use disorder professionals.

Members have direct access to plan providers of mental health and substance use disorder services without obtaining a referral from their primary care provider. However, covered mental health and substance use disorder benefits must be obtained through plan providers.

Behavioral health prior authorization

Looking for mental health and substance use disorder prior authorization guidance? It’s here.

Mental health

Do you have patients ready to schedule an appointment?

Have them contact a mental health and substance use disorder provider today.

SEARCH THE PROVIDER LIST

Download the provider directory

Patients can download a provider directory that lists all primary care physicians, specialists, hospitals, urgent care centers and pharmacies for their network.

The name of a patient's network can be found on the front of any Sharp Health Plan member ID card.


Coming soon: New Magellan Partnership

We are pleased to announce that we will be partnering with Magellan Healthcare, Inc.1 to manage mental health and substance use disorder services for all lines of business with an anticipated effective date of Jan. 1, 20242. Please see the following FAQ for more information.

Questions for non-mental health and substance use disorder providers

Why is Sharp Health Plan partnering with Magellan?

Sharp Health Plan is partnering with Magellan to ensure our members have access to best-in-class mental health and substance use disorder services that are rooted in integration, quality, and innovation. This exciting new partnership will significantly increase the mental health and substance use disorder provider network for our members, connect them with 24/7 access to personalized, evidence-based digital tools, wellness resources, and much more.


When will this partnership be effective?

The scheduled effective date for this partnership is Jan. 1, 20242.


Will this new partnership be applicable for all lines of business?

Magellan will be providing mental health and substance use disorder services for all Sharp Health Plan members, across all benefit plans including our commercial plans (HMO/POS), individual and family plans, and Medicare Advantage plans.


Do I need to do anything?

No. Please continue your current mental health and substance use disorder referral process.


Who should I contact with questions?

We will be sharing additional information with you in December. In the meantime, please contact our Provider Account Management team at provider.relations@sharp.com or 1-858-499-8330 with questions.


Who should my patients contact with questions?

If you have patients with questions, direct them to our online mental health and substance use disorder member center for more information, or to Customer Care at 1-844-483-9013.



Questions for mental health and substance use disorder providers

What does this mean for me and my patients?

If you are a Magellan participating provider, you will be able to continue seeing Sharp Health Plan members. Upon the effective date, you will bill Magellan directly for all covered mental health and substance use disorder services rendered to Sharp Health Plan members. Additionally, you will contact Magellan directly for covered mental health and substance use disorder services that require prior authorization, and for all appeals.

If you aren’t in the Magellan network, you will need to join to continue seeing Sharp Health Plan members. Magellan will be reaching out to you directly with additional information in the coming weeks. In the meantime, you can email Magellan if you have questions about joining their network. Be sure to include your name, organization or group name, TIN, contact email address and phone number when contacting Magellan.


What will happen to my Sharp Health Plan contract?

Our new Magellan partnership precludes us from having a Sharp Health Plan contract with any mental health or substance use disorder providers after the effective date of our Magellan partnership. Based on that requirement, we will send our mental health and substance use disorder providers a contract termination notice. Please note, if regulatory approval is not received in time, the Jan. 1 effective date may be pushed back to a later date. If this scenario occurs, your current contract with Sharp Health Plan will remain in effect until the effective date of the Magellan partnership. Nevertheless, we will notify you by Dec. 1, 2023 either confirming the Jan. 1 effective date or providing a later date.

If you are providing care through a Letter of Agreement (LOA) issued by Sharp Health Plan, you will not receive a letter of termination. Any claims for services authorized by Sharp Health Plan until the effective date of the Magellan partnership should be submitted to Sharp Health Plan. To request authorization for services after the effective date of the Magellan partnership, please contact Magellan.


Will you be communicating anything to patients?

Yes. We will be contacting Sharp Health Plan members who accessed mental health and substance use disorder services in 2023 to let them know if their provider is in the Magellan network or not. If their provider is in the Magellan network, they will be able to continue accessing care from that provider. If their provider isn’t in the Magellan network, we will share additional information with them, like how to request continuity of care and/or find another mental health and substance use disorder provider that is in the network.


What happens if I choose not to join the Magellan network?

We value our partnership with you, and sincerely hope you choose to join the Magellan network. That said, if you decide not to join, Magellan is able to offer continuity of care for qualifying Sharp Health Plan members by extending you a single case agreement, which will contain the same contractual terms and conditions in your contract with Sharp Health Plan. Please contact Magellan for more information.


As a Magellan provider, how will I check member eligibility and benefits?

Magellan uses Availity Essentials for eligibility and benefits verification. Stay tuned for details from Magellan about verifying eligibility and benefits.


As a Magellan provider, how will authorizations work?

Most outpatient mental health and substance use disorder services will not require prior authorization. A California Notice of Admission will serve as pre-authorization for inpatient admissions. Partial hospitalization, intensive outpatient, applied behavior analysis (ABA), electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and psychological and neuropsychological testing will require prior authorization. Magellan will share more information about authorization processes for these services for dates of service beginning Jan. 1, 20242. Magellan will honor existing prior authorizations for the duration of the authorization period for dates of service beginning Jan. 1 20242.


As a Magellan provider, how will claims processing work?

Claims for covered services rendered to Sharp Health Plan members for dates of service beginning Jan. 1, 20242, must be submitted to Magellan. Stay tuned for details from Magellan about the claims submission process for behavioral health and applied behavior analysis services.


Where can I find more information?

Please visit MagellanProvider.com/SharpHP for more information about serving Sharp Health Plan members.


Who should my patients contact with questions?

Please refer patients with questions to our online mental health and substance use disorder member center, or to Customer Care at 1-844-483-9013.


1. In California, Magellan does business as Human Affairs International of California, Inc.

2. Pending regulatory review with the DMHC, the effective date may be later than Jan. 1, 2024.