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Commercial provider forms

Commonly requested forms.

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Find forms and documents for you and your patients below including authorizations and referrals, medical, claim forms, and others you may need to manage your practice and care for your patients.

Select a category from the list below to view and download the forms you need.

 
Authorizations and referrals


  • Request precertification for a Point of Service (POS) or Preferred Provider Organization (PPO) member
  • Use this form to request pre-certification for a Sharp Health Plan POS or PPO member to receive health services from an out-of-network provider.
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  • file icon  English (PDF)

  • Request prior authorization for prescriptions or step therapy exception
  • Use this form to submit a prior authorization request for medications or step therapy.
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  • file icon English (PDF)

  • Request prior authorization for medical services
  • If a service requires prior authorization, use this form to submit a request to receive approval before scheduling a procedure. Providers who are rendering care to members assigned to a plan medical group (PMG) should contact the PMG for prior authorization.
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  • file icon  English (PDF)


 
Case management

  • Refer to case management or disease management
  • Use this form to refer a member to a case management or disease management program.
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    • file icon  English (PDF)


 
Claims and payments

  • Enroll in electronic data interchange (EDI) for claims submission
  • Use this form to submit a request to enroll in electronic data interchange (EDI) for claims submission and electronic remittance advice (ERA) in place of paper evidence of benefits (EOBs) and checks.
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  • Online form external link icon | file icon  English (PDF)

  • Request reimbursement for medical services
  • This form is for members who wish to request a refund form Sharp Health Plan for the cost of approved medical services. This form must be submitted directly by the member.
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  • file icon  English (PDF)

  • Request reimbursement for at-home COVID tests
  • Members can submit FDA approved at-home over-the-counter COVID-19 diagnostic tests for reimbursement beginning January 15, 2022.
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  • file icon English (PDF)

  • Dispute a payment or denial
  • Use this form to dispute any payments or denials that have been processed by Sharp Health Plan.
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  • file icon  English (PDF)


 
Grievances and appeals


  • File a grievance for cancellation of coverage
  • Members can use this form to file a grievance regarding the cancellation, rescission, or nonrenewal of their health care coverage to the Department of Managed Health Care (DMHC).
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  • Online form external link icon  |  file icon English (PDF)


 
Member management

  • Request to reassign a member to a new primary care physician
  • Use this form to assign your patients to a new primary care physician in your own plan medical group.
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  • Online form external link icon

  • Request to dismiss a member from plan medical group
  • This form is to be used by a Plan Provider’s office to request dismissal of a current member assigned under a Sharp Health Plan policy.
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  • Online form external link icon


Looking for Medicare provider forms?

You can find Medicare forms and authorizations on the Sharp Direct Advantage website.

Visit our Medicare website
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