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Read important notices, provider news and information, and newsletter archives below.

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IMPORTANT NOTICES

2019

Network Update for the Waco Area

The Ascension Providence health system has extended its contract with Scott and White Health Plan through December 31, 2020.

Updated Prior Authorization List Effective 11/01/19

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

Vision Network Change for Commercial Members

Beginning Nov. 1, 2019, in-network vision benefits for some of our commercial members will be offered through Scott and White Health Plan contracted optometrists and vision centers. A letter has been mailed to members informing them of the change from Superior Vision to directly contracted providers. Please verify benefits and eligibility at the time of service.

Cologuard Testing Benefit Change 05/23/19

To view related notice, click here.

SWHP Provider Relations Territory Map 05/21/19

To view map, click here.

Accessing eviCore’s Portal and Clinical Guidelines

Prior authorization requests for certain services must be submitted to eviCore Healthcare. Requests for prior authorization can be accessed via the SWHP provider portal. Once logged into the portal, visit the eviCore link. Providers will be directed to the eviCore portal login page. Clinical guidelines are also available as resources and accessible through the SWHP portal. Providers will be directed to eviCore's clinical guidelines page. The clinical guideline site does not require login credentials to view any of eviCore’s guidelines. Providers can also access this site here. To view frequently asked questions, learn more here.

Provider Directory Information Update

Our partners will be contacting you to update your provider information for our directories. Learn more here.

2018

Online Redetermination Requests

Providers can now submit redetermination requests online through the SWHP Provider Portal. Learn more here.

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.

2017

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.

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Provider News and Information

2017

September 26, 2017—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.

July 11, 2017—SWHP and Baylor Scott & White Quality Alliance (BSWQA) Integrated Care Model — SWHP and BSWQA Integrated Delivery means matching patients with a primary care doctor anchored in a Patient-Centered Medical Home (PCMH). The primary care doctor acts as the quarterback for care, treating the member and also directing care teams. It also means securely sharing information between primary and specialty care doctors, hospitals, labs, post-acute care facilities, as well as the insurance plan. By knowing the member’s whole health story, we can better manage their health and prevent unnecessary tests or procedures.

July 7, 2017—Employee Retirement System of Texas (ERS) — Plan Year 2018 Provider Network Change

July 5, 2017—MyBenefits Provider Portal Termination

June 23, 2017—Medicare Outpatient Observation Notice

June 8, 2017—Clear Claim Connection

January 26, 2017—For BSWH Employee Plan Only

January 4, 2017—SWHP Provider Relations Representatives Contact Information

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The Inside Story Newsletter Archive

2018

December 17, 2018 - The Inside Story Winter 2018

2017

January 24, 2017 - The Inside Story Winter 2017

2016

October 19, 2016 - The Inside Story Fall 2016

July 22, 2016 - The Inside Story Summer 2016

April 21, 2016 - The Inside Story Spring 2016

January 26, 2016 - The Inside Story Winter 2015/2016

2015

October 19, 2015 - The Inside Story Fall 2015

July 9, 2015 - The Inside Story Summer 2015

April 3, 2015 - The Inside Story Spring 2015

January 13, 2015 - The Inside Story Fall 2014/Winter 2015

2014

July 29, 2014 - The Inside Story Summer 2014

May 2, 2014 - The Inside Story Spring 2014

January 7, 2014 - The Inside Story Winter 2013

2013

October 25, 2013 - The Inside Story Fall 2013

June 1, 2013 - The Inside Story Spring/Summer 2013

2012

December 1, 2012 - The Inside Story Winter 2012

October 15, 2012 - The Inside Story Fall 2012

July 1, 2012 - The Inside Story Summer 2012

March 15, 2012 - The Inside Story Spring 2012

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Friday Focus Newsletter Archive

2017

October 6, 2017 - Future of Quality Measurement

February 3, 2017 - Diabetes: Best Practices

January 20, 2017 - Preventable Readmissions

January 6, 2017 - Off Label Drugs

2016

December 30, 2016 - FDA Approval of Drugs

December 23, 2016 - Emergence of Antibiotics

November 11, 2016 - Medication Reconciliation Post Discharge

October 7, 2016 - National Bullying Month

September 2, 2016 - What You Document Matters

August 26, 2016 - Diabetic Measures Success and Improvement

August 19, 2016- Spirometry Testing

August 8, 2016 - National Immunization Awareness

July 22, 2016 - Out of Network Referrals

July 1, 2016 - Unlocking the Stigma of Mental Disorders

June 17, 2016 - Early Mortality with ADHD

June 10, 2016 - Need a Colonoscopy?

June 3, 2016 - Safety is No Accident

February 5, 2016 - 5 Tips to Minimize Prior Authorization delays

2015

December 11, 2015 - Holiday Blues

December 4, 2015 - High Risk Medication Formulary Changes for Medicare Members

November 20, 2015 - CMS Awards Nearly $10 Million

November 13, 2015 - American Diabetes Awareness Month

November 6, 2015 - Cost Effective Care for Nausea and Vomiting in Pregnancy

October 30, 2015 - Affordable Care Act Open Enrollment

October 23, 2015 - Medicare Open Enrollment has Started

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New Prior Authorization Requirements — Evicore

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