Use the contact information below to get details about utilization management for Sharp Health Plan commercial members.
SCMG Graybill North Coastal and SCMG Palomar Health Medical Group Temecula
You are required to inform us when a member presents at your facility. Here’s everything you need to know.
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.
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.
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.
Here are some useful manuals and guides to help you better manage your Sharp Health Plan patients.
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.
Our Provider Relations team is here to help.
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