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IMPORTANT NOTICE: Jimmo v. Sebelius Settlement Agreement

Jimmo v. Sebelius Settlement Agreement – Skilled Nursing and Skilled Therapy Services — The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). For more detailed information, please visit the CMS website at https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html.

IMPORTANT NOTICE: Employee Retirement System of Texas (ERS) — Plan Year 2018 Provider Network Change

Effective September 1, 2017, the SWHP HMO Network for ERS was replaced with the BSW Preferred HMO Network. ERS members have been notified of this change.

You may receive inquiries from ERS members regarding your participation in the BSW Preferred HMO Network as a result of the network change. Providers and members can access the Find a Provider search tool by going to http://ers.swhp.org/home. The search tool can be used to see participating providers in the BSW Preferred HMO Network by clicking on the link for Plan Year 2018 — Find a Provider.

IMPORTANT NOTICE: MyBenefits Provider Portal Termination

Effective August 31, 2017, SWHP terminated the MyBenefits Provider Portal accessible through https://swhpah.swhp.org/.

We recently introduced the SWHP Provider Portal, which should be providers' first stop for checking claims status, member benefits and eligibility, reimbursement rates for codes, and explanations of claims denial codes. The SWHP Provider Portal can be accessed by going to https://portal.swhp.org/ProviderPortal/#/login.

ANNOUNCEMENT: Scott & White Health Plan Provider Relations Representative Contact Information

To identify who your PR Rep is, please use the territory map, which lists the name and cell phone number of each PR Rep along with a color-coded legend that shows the counties that each PR Rep covers. The PR Reps serve as your liaison with SWHP. They are available to assist you with information regarding SWHP’s policies, procedures, questions, and issues or concerns.

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