Precertification is the process of confirming that a patient is eligible on a benefit plan to be covered by the payer and to collect information prior to the admission or service. This process should inform all parties in advance of treatment; identify patient for pre-service discharge planning and register patients for Case Management and Disease Management when needed.
SHARP provides precertification services as required by the plan for the following employer plans and insurance companies. Please complete a SHARP Precertification Request Form and fax to SHARP’s confidential fax number (870) 935-9934.
- Acclaim TPA: All inpatient services for members covered by their plan admitted to facilities in the state of Arkansas only.
- Arkansas Methodist Medical Center:All Inpatient Services, CT, MRI, PET Scans
- Arkansas Glass Container Corporation:All Inpatient Services, Outpatient Surgery, Inpatient Mental Health Treatments, Skilled Nursing Facility Stays, Transplants, PET Scans, Nuclear Medicine, Home Health Care, Home Infusion Services, Hospice Care, DMEs over $1,000, Diabetic Teaching, and Dialysis
- Lawrence Health Services: All Inpatient Services, Mental Health Treatment, Transplant Services, Ultrasounds for Pregnancy, Prenatal/Maternity Care, Home Health Care, Home Infusion, Hospice Care, DME over $1000, Diabetic Teaching, PET Scans, Nuclear Medicine. Imaging Services - SHARP provides precert services for Lawrence Health Group's imaging services. Do Not Call CoreCare National for the Lawrence Health Group.
- Lifestyle Health Plans: All Inpatient Services
- SBBH: All Inpatient Services, Outpatient Surgery, CT, MRI, PET Scans **Private Duty Nursing Services (must be pre-authorized before services are rendered)
- SBMC: All Inpatient Services, Outpatient Surgery, CT, MRI, PET Scans **Private Duty Nursing Services (must be pre-authorized before services are rendered)
- St. Bernards Owned Clinics Group/ Regional Health Care Holdings, Inc.: All Inpatient Services, Outpatient Surgery, CT, MRI, PET Scans **Private Duty Nursing Services (must be pre-authorized before services are rendered)
- Total Life Healthcare: All Inpatient Services, Outpatient Surgery, MRI and CT Scans, Hyperbaric Therapy, Nuclear Medicine
Case Management is a collaborative process of assessing, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes.
This service is provided for patients with potentially catastrophic illnesses, for example, high-risk pregnancies, or acute illnesses such as cancer. This service is also for patients with on-going diseases such as diabetes.
The case management process should inform all parties of insurance coverage and benefits, coordinate the services associated with discharge or return home, provide patient education, negotiate rates with providers who are out of network, and coordinate services with other healthcare providers.
SHARP currently provides case management services for the following health plans:
- Arkansas Glass Container Corporation
- Arkansas Methodist Medical Center
- Lawrence Health Services
- Lifestyle Health Plans
- St. Bernards Behavioral Health
- St. Bernards Medical Center
- St. Bernards Owned Clinics Group/ Regional Health Care Holdings, Inc.
The wisdom of investing in a narcotic review has finally made its way into the national conversation. Everyone now knows that most health plans have abuse of narcotics and they are costly to the employer. We are tackling the issue of narcotic review. Our team is focused on considerate communication and customer service to assist the employer and employees in this process. Our review is conducted by a Board Certified Physician.
Employers are looking for solutions that reduce healthcare costs. Paying for unneeded medication is not fair to the employer or the workforce. Patient safety, unnecessary medication and higher cost are concerns with unchecked narcotic use.
We have the expertise to make it happen in a confidential, easy manner.
St. Bernards Medical Center and St. Bernards Clinic employees/dependants can download the required forms and fax to (870) 972-0036.
St. Bernards Medical Center Form
St. Bernards Medical Clinic Form
For more information contact Beverly Nix Stone at (870) 972-0032.