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Get Ca Sharp Health Plan Provider Dispute Resolution Request 2022-2024

UTE and EXPECTED OUTCOME. Provide additional information to support the description of the dispute. Do not include a copy of a claim that was previously processed. Multiple LIKE claims are for the same provider and dispute but different members and dates of service. For routine follow-up, please use the Claims Follow-Up Form instead of the Provider Dispute Resolution Form. Sharp Health Plan Mail the completed form to: Attn: Provider Dispute Resolution 8520 Tech Way, Suite 200 San Diego, CA.

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