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IMPORTANT NOTICE: 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.

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IMPORTANT NOTICE: 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.

ProvidersProviders News & Information

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Provider News and Information

January 2017

January 26, 2017—For BSWH Employee Plan Only

January 4, 2017—SWHP Provider Relations Representatives Contact Information

 

June 2017

June 8, 2017—Clear Claim Connection

June 23, 2017—Medicare Outpatient Observation Notice

 

July 2017

July 5, 2017—MyBenefits Provider Portal Termination

July 7, 2017—Employee Retirement System of Texas (ERS) — Plan Year 2018 Provider Network Change

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.

 

September 2017

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.