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

For more information about the AB 1455 regulation, please visit California Department of Managed Health Care.

Sharp Community Medical Group fee schedules

• Immunization Administration Fee Schedule

• Medicare Fee Schedule - Classified (3rd Quarter 2024)

• Medicare Fee Schedule - Unclassified (3rd Quarter 2024)

• Vaccine Fee Schedule (1st Quarter 2025)

A message to contracted providers, vendors and facilities

Sharp Community Medical Group 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.