skip to main content

Enter Title

Statutory Verifcation

ProvidersSubmit a ClaimClaims ResourcesStatutory Verification

Text/HTML

About Statutory Verification

Senate Bill 418, enacted by the Texas Legislature, allows our contracted providers to verify payment of a claim for a member. Known as statutory verification, this serves as a guarantee of payment, if granted.

Declination

Declination is the refusal to give statutory verification. This does not equate with claim denial or adverse determination. It simply means we are unable to guarantee payment based upon the information we have at the time of the declination. We’ll let you know the reason if we issue a declination.

Requirements

When requesting a statutory verification, you’ll need to provide:

  • Name of provider
  • Provider’s federal tax ID number
  • Patient name
  • Patient SWHP ID number
  • Patient date of birth
  • Patient relationship with enrollee
  • Presumptive diagnosis, if known; otherwise, presenting symptoms
  • Description of proposed procedure or procedure codes
  • Place of service code where services will be provided; if other than provider’s office, name of hospital or facility where proposed service will be provided
  • Proposed date of service
  • Group number
  • Name and contact of any other carrier, if known to provider

To request a statutory verification, contact us and provide the state mandated required elements. For a routine care statutory verification, we will will respond within five days.