Medical prior authorization

Services that require precertification for members enrolled in benefits through our point of service (POS) or preferred provider organization (PPO).

VIEW/DOWNLOAD PPO/POS PRECERTIFICATION LIST

Our prior authorization list makes it easier to determine when prior authorization is required for a particular service. Note that these guidelines are specific to services for members enrolled in HMO plan and assigned to providers who are independently contracted with Sharp Health Plan. For members assigned to a different plan medical group (PMG), providers should contact the PMG directly for details and their referral and authorization processes. The PMG is identified on the member's identification card.

VIEW/DOWNLOAD MEDICAL PRIOR AUTHORIZATION List

Utilization management program

Our medical prior authorization guide is part of our utilization management program, which ensures members have access to the high-quality, cost-effective medical services they need, when they need them. Learn more about this program in the provider operations manual.

Fill out a prior authorization form

Please complete an authorization request via the Provider Portal (if access is available). If not, please complete the appropriate prior authorization form in its entirety. Incomplete forms will be faxed back to sender. Fax the completed form to 1-619-740-8111.

Be sure to include any clinical documentation to support your authorization request. Include anything that may be important to review such as chart notes, imaging, or lab data. The more information you provide, the better we can fulfill your request.

Have a question?

You can contact Customer Care at 1-858-499-8300.

• Toll free: 1-800-359-2002
• Dedicated provider line: 1-844-483-9012

Or you can email us at customer.service@sharp.com.

Have behavioral health questions?

Contact Optum Behavioral Health at 1-844-483-9013 or visit the Optum Provider Express portal.