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
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
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,
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,
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.