Utilization management

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

 

Utilization management contact information

For members assigned to the following Plan Medical Groups (PMGs),
please contact the PMG directly for details.

Plan Medical Groups (PMG)Contact Number
Sharp Community Medical Group - Arch 858.613.8910
Rady Children's Health Network/CPMG858.309.6270
Greater Tri-Cities IPA1.877.207.7600
Primary Care Associates Medical Group760.542.6757
Sharp Community Medical Group1.877.518.7264
Sharp Community Medical Group Graybill and Temecula760.291.6615
Sharp Rees-Stealy Medical Group858.499.2600
 

Manuals and guides

Here are some useful manuals to help you better manage your Sharp Health Plan patients, including operations manuals and an Authorization Claims Enrollment System (ACES) user guide.

MORE INFORMATION ➜

Provider forms

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

DOWNLOAD FORMS ➜

Language assistance

We provide free interpreter and translation services for all members. For assistance, call Customer Care at 1.800.359.2002 and let us know your preferred language when you call. We’re glad to help.

LEARN MORE

Prior Authorization Guide for independent providers

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

LEARN MORE ➜
 

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.

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