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Medical Authorizations

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IMPORTANT NOTICE: Retroactive Authorization Requests

Effective June 1, 2017, the SWHP Health Services Department (HSD) no longer accepts retroactive authorization requests. If a service requires prior authorization and the authorization is not obtained prior to the service being rendered, the claim for the service will be denied.

The SWHP HSD will continue to accept retroactive notifications for the limited services that require one. A reference number will be provided for the notification. For more information, please do not hesitate to contact the SWHP HSD at 1-888-316-7947.

IMPORTANT NOTICE: For BSWH Employee Plan ONLY.

All SWHP non-contracted provider requests for prior authorization are processed by Cigna. 

Please take the following steps to ensure your request is processed in a timely manner:

  • You MUST FIRST verify benefits and eligibility with SWHP by phone. Call 1-844-769-3994 and speak to a customer advocate.
  • When verification is complete, you may have the advocate transfer you directly to Cigna, OR you may contact Cigna at 1-866-494-4872 to determine prior authorization requirements and initiate prior authorization requests.
ProvidersAuthorizationsMedical Authorizations

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Medical Authorization Requests

Prior authorization is required for the medical services, procedures and supplies listed in the respective list.

Prior Authorization Lists

For any item on the prior authorization list, be sure to complete a prior authorization request. The forms are based on the Texas Department of Insurance (TDI) Standardized Prior Authorization Form.

SWHP Prior Authorization Forms

Health Services Division accepts prior authorization and peer-to-peer requests during regular business hours (8 a.m. to 5 p.m.) and any time after hours in the following ways:

  • Online: Log in to the secure Provider Portal to complete and submit the Prior Authorization form.
  • Fax: Download and complete the Prior Authorization form and cover sheet, then fax it to 1-800-626-3042.
  • Phone: For after-hours urgent admissions, or if online or fax submission is not possible, providers may call the Health Services Division directly: 1-254-298-3088 or 1-888-316-7947.

Medical Coverage Policies

Continuity of Care – Transition of Care Policy and Forms

Medical Management