Submitting claims

Simplify the claims process with these self-service tools and resources.

Submitting claims has never been easier! For the best provider experience, we recommend using one of our approved claims clearinghouses to submit and manage your claims electronically.

Why submit claims online?

  • Confirmation your claim was received
  • Ability to track claim status
  • Eliminate paper requests
  • Improved cost effectiveness

Approved Sharp Health Plan clearinghouses

Capario (Change Healthcare)
1-800-792-5246 |
Sharp Health Plan Payer ID: SHPPN

Office Ally
1-360-957-7000 |
Sharp Health Plan Payer ID: SHP01

Trizetto (Gateway EDI)
1-800-556-2231 |
Sharp Health Plan Payer ID: SHP76

Waystar (Zirmed)
1-844-492-9782 |
Sharp Health Plan Payer ID: SHP102

Your Sharp Health Plan Online Account

You can also submit claims and check the status of a claim through your Sharp Health Plan online account. If you don’t have an account, you can use our guest claims check online.

Clean claims

Make sure your claims are submitted correctly by following the guidelines. Doing so will ensure your claims are processed accurately and timely.


Get paid faster

Avoid delays by signing up for direct deposit. By enrolling in the EFT (Electronic Funds Transfer) service, you can get your money in a safer and more convenient way.


Overpayments and retractions guide

Our policies and procedures guide is a handy resource that can help you with the process of claims overpayments and retractions.


Claims settlement practices

See our practices for claim submission and overpayments, the dispute resolution process, and fee schedules.


See our dispute resolution policy

Get an overview of the process, documentation and steps we take to resolve provider claims disputes.


Provider Operations Manual

Looking for more information about our claims processes? View and download the Provider Operations Manual for the commercial and Medicare lines of business.

If something doesn’t seem right, tell us

Health care fraud results in higher premiums and reduced budgets, which can negatively impact the quality of health care. Learn about our efforts and what you can do to help.


Process of internal audits

Find useful information about audit criteria, required documentation, and the rules and regulations for ensuring health care compliance.


Claims negotiation policy

Attention non-contracted providers: here you will find our guidelines for processing claims.


Grace periods for members

Here’s what you need to know if your patient’s premium payment is late.


Prior auth claims and level one guidelines

Use this document to understand Sharp Health Plan's guidelines for processing claims that may require a prior authorization. 


Stay on top of the latest news from Sharp Health Plan