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
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 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
MyBenefits Provider Portal Termination
Medicare Outpatient Observation Notice
Clear Claim Connection
For BSWH Employee Plan Only
SWHP Provider Relations Representatives Contact Information