Sharp Health Plan’s utilization management guidelines are designed to help you and your patients.
Prior authorizations for outpatient drugs covered under the pharmacy benefit are automatically extending, when clinically appropriate. This applies to all patients with prior authorizations set to expire between March 23 and June 30, 2020.
Please use the contact information below to get details about utilization management for Sharp Health Plan commercial members.
Our prior authorization guide makes it easy to determine when prior authorization is required for a particular service. Note that these guidelines are specific to services for members enrolled in an HMO plan and assigned to providers who are independently contracted with us.
If you would like to prescribe a medication that requires authorization, you’ll need to fill out the prior authorization request form and give us any relevant support or documentation. Once the form is complete, we can review your request.
See what behavioral health and chemical dependency services require prior authorization for our commercial plan members.
Here are some useful manuals and guides to help you better manage your Sharp Health Plan patients.
Browse, download, and print enrollment forms, authorization request, appeal requests, and other useful documents.
You can find Medicare forms and authorizations on the Sharp Direct Advantage website.
Language assistance program
Quality care depends on clear communication between you and your patients. Get the right support so that no questions are left unanswered.
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.
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