Utilization management

Sharp Health Plan’s utilization management guidelines are designed to help you and your patients.

 

Utilization management contact information

Please use the contact information below to get details about
utilization management for Sharp Health Plan commercial members.

For behavioral health and chemical dependency servicesContact Number
Sharp Health Plan1-858-499-8300
For medical servicesContact Number
Greater Tri Cities IPA1-877-207-7600
Individually contracted providers1-858-499-8300
Primary Care Associates Medical Group1-760-542-6757
Rady Children's Health Network / CPMG1-858-309-6270
Sharp Community Medical Group – Arch1-858-613-8910
Sharp Community Medical Group Graybill and Temecula1-760-291-6615
Sharp Community Medical Group1-877-518-7264
Sharp Rees-Stealy Medical Group1-858-499-2600
 

Manuals and guides

Here are some useful manuals and guides to help you better manage your Sharp Health Plan patients.

MORE INFORMATION ➜

Medical prior authorization guide for independent providers

Use this helpful guide to determine when prior authorization is required for a particular service.

SEE GUIDE ➜

Provider forms

Browse, download, and print enrollment forms, authorization request, appeal requests, and other useful documents.

DOWNLOAD FORMS ➜

Mental health services

Learn how to help members get access to the services they need for diagnosis and treatment of behavioral health conditions.

LEARN MORE ➜

Behavioral health and chemical dependency prior authorization request guide and form

Use our helpful guide below to determine when prior authorization is needed for a specific behavior health and chemical dependency service.

If your service requires prior authorization, please fill out this form and fax it to 1-619-740-8111 to receive approval.

DOWNLOAD GUIDE ➜
 

Pre-certification for POS plans

Members with POS plans can choose the providers and level of coverage that work best for them. If they choose an out-of-network provider, their out-of-pocket costs will be higher. Members don’t need a referral from their primary care physician, but some services require pre-certification. Refer members to the health plan benefits and coverage matrix for details on deductibles, copayments, and coinsurance for the POS plans’ HMO Benefit Level and OON Benefit Level.



Download pre-certification form

Have questions? Our Provider Relations team is here to help.