Interoperability and prior authorization

Prior authorization metrics for medical items and services (excluding drugs)

To comply with the CMS Interoperability and Prior Authorization final rule, Sharp Health Plan is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers. For questions on the data below, contact: Customer Care Monday to Friday, 8 am to 6 pm at 1-800-359-2002.

Reporting Period: 2025

Sharp Health Plan Medicare Prior Authorization 2025 Metrics

Standard prior authorization requests

Expedited prior authorization requests

Time between receiving a prior authorization request and sending a decision

Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.

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