Use our guide to determine when prior authorization is required. Guidelines are specific to services for members enrolled in an HMO plan and assigned to providers who are independently contracted with us.
Not sure if a member needs a referral, authorization, or notification prior to receiving care? Use this guide to quickly find out whether you need to fill out forms and how to submit them.
To prescribe a medication that requires authorization, complete the prior authorization request form and provide any relevant support or documentation.
See what mental health and substance use disorder services require prior authorization for our members.
We’ve adopted a series of guidelines to help your team improve your patients' health.
Find out the American Academy of Pediatrics’ and American Congress of Obstetrician and Gynecologists’ most recent recommendations on quality care for pregnant women and their babies.
Learn how to help members get access to the services they need for diagnosis and treatment of behavioral health conditions.
Find out how members can access acupuncture or chiropractic services through American Specialty Health.
Help eligible members who are pregnant, or have been pregnant in the past 12 months, access support from a contracted doula.
Get helpful reminders about how to comply with the timely access laws, which outline maximum wait times for telephone calls and appointment requests.
Learn how to help members get covered outpatient prescription drugs from local, Sharp Health Plan-contracted pharmacies.
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