Member Services

Provider Network

The SHARP Provider Network currently includes approximately 300 physicians, fifteen local and referral facilities, and other allied health care providers. Through these affiliations our provider network offers access to every medical service available in the northeast Arkansas area as well as tertiary referral centers in Little Rock, Arkansas and Memphis, Tennessee for care that must be referred out of the local area. Our contractual arrangements with our provider partners offer significant savings on healthcare services.

SHARP performs its own physician credentialing using current National Committee for Quality Assurance (NCQA) standards.

Case Management

SHARP provides Case Management services for those patients with special needs outside of our normal network of providers. Patients suffering from catastrophic, long term, high risk or costly illnesses or injuries can benefit from our Case Management program. Services such as durable medical equipment, home IV, and referrals to specialized treatment facilities can be coordinated through our Case Management Department and significant savings can be realized both by the payer and the patient. SHARP works with many of the area vendors to provide these services.

Utilization Review & Medical Management

SHARP is licensed to provide prospective, concurrent, and retrospective review for inpatient and outpatient medical services under our Utilization Review and Medical Management programs. We use nationally accepted criteria to monitor inpatient admissions for appropriateness of care and length of stay. The SHARP physicians have also developed several Practice Guidelines to help provide consistent, cost effective, high quality healthcare services to their patients.

Claims Repricing

SHARP performs healthcare claims repricing services for our employer clients. This assures the most accurate application of the provider contract terms which maximizes the savings to both the patient and their employer. SHARP is also able to provide both client-specific and area-wide reports to our client and provider partners to help identify additional ways that we can work together to contain healthcare costs while maintaining a high level of care.

If you have questions...

There are several different organizations that are involved in making a healthcare plan work smoothly and they all have different responsibilities. If your plan is self-insured you probably have a Third Party Administrator (TPA) that is hired to do all the administrative functions. TPAs take care of things like paying the claims, keeping up with how much of your deductible you’ve met for the year, applying the plan benefits, and sending out your Explanation of Benefits when a claim is processed. If your plan isn’t self-insured, the insurance company usually does these things. Questions about how a claim was processed typically go to your TPA or insurance company.

You may also have a Preferred Provider Network (like SHARP) as a part of your plan. If you do, that means that you have better benefits if you use certain physicians and hospitals and, if you use those providers, you and the company save money because the network offers preferred pricing for medical services. Provider-related questions (like if a certain doctor or hospital is in the network) usually go to the network.

If your plan requires you to call before you are admitted to a hospital, or perhaps before certain outpatient procedures are done, you have precertification as part of your plan. Precertification may be handled by the TPA, the Network, or by a separate company. The main idea here is that usually there is some kind of financial penalty if the call isn’t made. So make sure you, someone in your family, your doctor, or the hospital makes the call within the required timeframe. The precertification telephone number should be listed for you on your insurance card.

Last Updated: 6/25/2008