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COVID-19: We're here for you

As we continue to monitor the spread of COVID-19, we are committed to keeping you informed. Provider Relations representatives are available by phone, as always. Click here for COVID-19 updates.

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.

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

2020

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

2019

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.

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. Learn more.

Employee Retirement System of Texas (ERS) — Plan Year 2018 Provider Network Change

Learn more.

MyBenefits Provider Portal Termination

Learn more.

Medicare Outpatient Observation Notice

Learn more.

Clear Claim Connection

Learn more.

For BSWH Employee Plan Only

Learn more.

SWHP Provider Relations Representatives Contact Information

Learn more.

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The Inside Story Newsletter Archive

2019

December 23, 2019 - The Inside Story Winter 2019

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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