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.
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
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.
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.
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
For more detailed information, please visit the CMS website at https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html.