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Physician/Provider Advisory Group (PAG) Quarterly Meeting

Scott and White Health Plan and FirstCare Health Plans would greatly appreciate your attendance at the virtual Physician/Provider Advisory Group (PAG) Quarterly Meeting on Friday, May 21, 2021, from noon to 1:30 p.m. Register for Our Upcoming PAG Meeting.

Motivational Interviewing that Encourages Medication Compliance

Kael A Kuster, MD, Scott and White Health Plan’s Behavior Health Medical Director, will host a presentation on motivational interviewing and how it can be used to encourage patients to take their medications as prescribed. Informational flyer.

Provider Customer Service FAQ

The new year has brought many new members to our health plan, and we're receiving more phone calls than usual. We apologize for any wait you may experience and are actively working to reduce hold times. Please see the Provider Customer Service FAQ for additional communication options and other helpful information.

IVR and Portals Guide

To assist you with claims processing, we've created a new guide for our Interactive Voice Response System (IVR) and provider portals. Please refer to the IVR and Provider Portals Guide for members of Scott and White Health Plan, FirstCare Health Plans, RightCare (Medicaid), and STAR and CHIP. You can find helpful information on: IVR phone numbers, Portal websites, Claims mailing addresses, and Member ID numbers

Verifying Eligibility

As we transition to a new claims system, the correct portal to verify eligibility will vary by member. Most members can be verified through swhpprovider.firstcare.com. Otherwise, please visit portal.swhp.org/providerportal. Note that the applicable provider portal is listed on the member’s ID card.

COVID-19 Vaccine: The COVID-19 vaccine will be available to health plan members at zero out-of-pocket cost

Find out more here.

We are committed to keeping you informed. Provider Relations representatives are available by phone, as always. Click here for COVID-19 updates.

COVID-19 Testing/Treatment: Effective March 6, 2020, and until further notice, Scott and White Health Plan is waiving member cost-sharing for care related to COVID-19, which includes testing, telehealth services, outpatient office visits and inpatient hospital stays. This applies to fully insured Commercial and Medicare Advantage members; self-funded customers may also elect to implement this coverage for their employees. Cost-sharing does not apply to Medicaid members.

ANNOUNCEMENT: Kidney health support services through new collaboration with Cricket Health

Scott and White Health Plan is pleased to collaborate with Cricket Health to provide patient-centered, multidisciplinary care to SWHP Medicare Advantage members living with late-stage chronic kidney disease (CKD) or end-stage renal disease (ESRD). Visit Cricket Health or get more information here.

Provider/Physician Notice

View the COVID-19 Telehealth and Telemedicine Policy for coding guidelines and claims submission procedures. We have also reduced our Prior Authorization Requirements.

Hospital Without Walls

The Health and Human Services Commission (HHSC) adopted emergency rules in response to the state of disaster declared in Texas and the United States of America related to COVID-19. As part of the CMS Hospital Without Walls initiative, hospitals can provide hospital services in other healthcare facilities and sites not currently considered to be part of a healthcare facility or set up temporary expansion sites to help address the urgent need to increase capacity to care for patients, in response to the COVID-19 pandemic.

Additional information is available online at: https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation

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Provider Section

Read provider news and information and newsletter archives below.

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Provider News & Information

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2021

Quality Improvement webinar for ADHD HEDIS Measure (Initiation Phase).

Portia Green, SWHP’s Clinical Quality Improvement Coordinator, will host a presentation on follow-up care for children prescribed medications for attention-deficit hyperactivity disorder. This presentation is part one of a two-part series on the initiation and continuation phases of ADHD treatment. For more Information please click here.

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2020

Dr. Hellerstedt Statement On Vaccine Administration

DSHS Commissioner John Hellerstedt, MD, today released the following statement on vaccine administration in Texas:

All providers that have received COVID-19 vaccine must immediately vaccinate healthcare workers, Texans over the age of 65, and people with medical conditions that put them at a greater risk of severe disease or death from COVID-19. No vaccine should be kept in reserve.

Important Announcement: Commercial Health Plan Integration- Federal Employees Health Benefits (FEHB) Program

Scott and White Health Plan (SWHP) is transitioning commercial business to a new claims system in a phased approach. Federal Employees Health Benefits (FEHB) Program is the next group to transition, beginning 1/1/2021. All claims for dates of service 1/1/2021 and after for these members will be processed in the new claims system. Read the notice.

Cricket Health kidney health program launches November 11, 2020, for Medicare Advantage members

Find out more about how this CKD and ESRD patient care program can benefit your SWHP Medicare Advantage patients. Read the notice.

Important Announcement: Commercial Health Plan Integration

Scott and White Health Plan (SWHP) is transitioning commercial business to a new claims system in a phased approach. Bell County is the next group to transition, beginning 11/1/2020. All claims for dates of service 11/1/2020 and after for Bell County members will be processed in the new claims system. Read the notice.

Important Announcement: Sixty-Day Notification for Prior Authorization List Change

The September 1, 2020 versions of the Prior Authorization list for Scott and White Health Plan will include new categories. Specifically, medical drugs requiring prior authorization will be presented in a series of 46 categories. Read the notice.

Important Announcement: Commercial Health Plan Integration – City of Temple

Scott and White Health Plan (SWHP) is transitioning commercial business to a new claims system in a phased approach. City of Temple is the next group to transition, beginning 10/1/2020. All claims for dates of service 10/1/2020 and after for City of Temple members will be processed in the new claims system. Read the notice.

Claims System for SWHP TAMU and Health Plus Patients Is Changing

Scott and White Health Plan (SWHP) is transitioning to a new claims system in a phased approach that will affect Texas A&M (TAMU) and Health Plus members starting 7/01/2020. All claims for date of service 7/01/2020 and after for TAMU and Health Plus members will be processed in the new claims system. Read the notice.

Claims System for SWHP TRS ActiveCare Patients Is Changing

Scott and White Health Plan (SWHP) is transitioning to a new claims system in a phased approach that will affect Teacher Retirement System of Texas (TRS ActiveCare) members starting 9/1/2020. All claims for dates of service 09/01/2020 and after for TRS ActiveCare members will be processed in the new claims system. Read the notice.

Referring Provider Identifiers for Medicare Part C Durable Medical Equipment (DME) Claims

Scott and White Health Plan is reinforcing the requirement to include the referring physician’s NPI on all DME claims. The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage Organizations to submit encounters for DME with the referring physician NPI. Read the notice.

Hospital Without Walls

The Health and Human Services Commission (HHSC) adopted emergency rules in response to the state of disaster declared in Texas and the United States of America related to COVID-19. As part of the CMS Hospital Without Walls initiative, hospitals can provide hospital services in other healthcare facilities and sites not currently considered to be part of a healthcare facility or set up temporary expansion sites to help address the urgent need to increase capacity to care for patients, in response to the COVID-19 pandemic.

Additional information is available online at: https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation

Important Announcement: Commercial Health Plan Integration

Scott and White Health Plan (SWHP) is in the process of transitioning to a new claims system. The transition will be in a phased approach with important changes.

Effective 07/01/2020, claims for date of service 07/01/2020 and after for Texas A&M (TAMU) and HealthPlus members will be processed in the new claims system. Click here for claims and ID card details.

Updated Prior Authorization Fax Cover Sheet

Scott and White Health Plan has updated the coversheet to the medical benefit Prior Authorization form which can be found here. When requesting medical drugs, a NOTE is included to identify the appropriate route to submit the request. Read the Prior Authorization Fax Cover Sheet update memo.

Expecting the Best®

Scott and White Health Plan is pleased to offer Expecting the Best®, a maternity program focused on helping expectant mothers enjoy a healthy pregnancy. We can assist your office with care coordination of our members to enhance patient experience, resulting in increased positive outcomes. Read the flyer.

Attention: BSW Preferred Providers contracted with Scott and White Health Plan

Effective January 1, 2020, the Baylor Scott & White Health Quality Alliance is administering DFWConnectedCare, an American Airlines Plan. Learn more. Read Provider Q&A.

Updated Prior Authorization List Effective 02/01/2020

SWHP will be updating Prior Authorization Lists for our Commercial, Medicare Advantage, and Baylor Scott & White Health Employee plans. Prior Authorization Update Memo

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The Inside Story Newsletter Archive

2021

January 22, 2021 - The Inside Story Winter 2021

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New Prior Authorization Requirements — Evicore

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