Provider News and Information
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