About Sharp Health Plan clinical policies
Sharp Health Plan develops clinical policies that serve as guidelines for medical necessity determinations, based on medical evidence such as:
- Guidelines from nationally recognized health care organizations
- Guidelines published by nationally recognized professional organizations
- Available protocols regarding use of drug, device, procedure or therapy adopted by academic institutions
- Peer-reviewed medical and scientific literature
- Evidence-based consensus statements
All Sharp Health Plan clinical policies are the intellectual property of Sharp Health Plan. No part of our clinical policies may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying,
or otherwise, without permission from the Plan.
Who develops the clinical policies for Sharp Health Plan?
Our clinical policies are written by board-certiﬁed, California-licensed physicians, then edited and approved by a committee of physicians including primary care and specialists.
How does Sharp Health Plan keep its clinical policies up to date?
Each clinical policy is reviewed and updated yearly. The yearly review includes analysis of new peer-reviewed literature and new professional society guidelines.
How do providers use Sharp Health Plan clinical policies?
Providers use our clinical policies as reference in conjunction with the independent judgment of the treating qualiﬁed licensed physician(s).
Sharp Health Plan clinical policies do not constitute the practice of medicine or medical advice. They are not
intended to dictate to providers how to practice medicine, and they are not intended to recommend
treatment for members. Members should consult with their treating provider in connection with diagnosis and treatment decisions.