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
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.
Online Redetermination Requests
Providers can now submit redetermination requests online through the SWHP Provider Portal. Learn
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.
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
For more detailed information, please visit the CMS website at https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html.