Claim Settlement and Dispute Resolution Practices
Download documents about claims and related disclosures.
The following documents meet AB 1455, the Department of Managed Health Care regulation that requires medical groups to post the notice documents related to claim settlement and dispute resolution practices. You will need Adobe Acrobat Reader to view and download these files.
- Billing and Claim Payment Procedures
- Claims Settlement Practices, Dispute Resolution Mechanism and Fee Schedule Disclosures
- Provider Dispute Resolution Request Form
Sharp Community Medical Group (SCMG) Fee Schedules
- Immunization Administration Fee Schedule - Updated Oct. 2016
- Medicare Fee Schedule - Classified (4th Quarter 2017) - Updated Sept. 2017
- Medicare Fee Schedule - Unclassified (4th Quarter 2017) - Updated Sept. 2017
- Vaccine Fee Schedule - Updated Nov. 2017
For More Information
To learn more about the AB 1455 regulation, please visit the California Department of Managed Health Care.
A Message to Contracted Providers, Vendors and Facilities
SCMG practitioners make utilization management decisions based only on appropriateness of care and service and existence of coverage. Practitioners and individuals who conduct utilization review are not rewarded for denials of coverage or service care and there are no financial incentives for utilization management decision makers to encourage decisions resulting in underutilization.