Providers - Verify eligibility and check claim statuses as a guest (2024)

What information do I need to enter to check eligibility?

Enter the following information:

  • Provider NPI*
  • Member ID*
  • Date of Birth*
  • Last 4 of SSN
  • ZIP Code
  • The date you want to verify eligibility for

* This information is required.

What information do I need to enter to check a claim status?

Enter the following information:

  • Provider NPI or Vendor Tax ID
  • ID + Earliest Date of Service or ID + Billed Amount

Who should I contact if I have questions or need support?

Please reach out to the provider account management team by completing this contact form.


Providers - Verify eligibility and check claim statuses as a guest (2024)

FAQs

What is eligibility in insurance? ›

Eligibility is usually determined by factors such as employment status, age, relationship to the policyholder, and enrollment in a specific insurance plan.

How do I check the status of my Sharp Health Plan claim? ›

How to verify eligibility and check claim statuses. Visit sharphealthplan.com/login and find the Providers section. Select the verify eligibility or check claims status link. Enter the required information and select Search.

What does verify eligibility mean? ›

Eligibility verification in healthcare refers to the process of confirming a patient's coverage and benefits with their insurance provider.

Why is it important to verify eligibility? ›

By verifying eligibility, practices can determine a patient's medical insurance coverage status prior to the appointment and report demographic information accurately on insurance claims.

What are examples of eligibility? ›

Having a valid driver's license means you have the eligibility to drive a car. The noun eligibility is good for describing the state of being qualified for or worthy of something. You might have the eligibility to take an upper level computer class, but not have the eligibility to take advanced Arabic, for example.

What does your eligibility mean? ›

: the quality or state of being eligible : fitness or suitability to be chosen, selected, or allowed to do something. The applicants must meet all requirements for eligibility.

How do you define eligibility? ›

the fact of having the necessary qualities or satisfying the necessary conditions: I'll have to check her eligibility to take part.

What does eligibility date mean in insurance? ›

Effective Date: The date on which health insurance coverage comes into effect. Eligibility Date: The date on which a person becomes eligible for insurance benefits.

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