Providing Services to SWHP Members
If you are a provider in the PHCS Primary Network or PHCS Healthy Directions Network and have opted in to participate with SWHP, then you may have some SWHP members that seek medical services from you. To identify the SWHP members that can seek medical services from you as a PHCS provider, the member ID cards will have the PHCS logo on the back of them. An example of the PHCS logo that is on the back of the member ID cards can be viewed here.
Prior Authorization List
Click here to view the SWHP Prior Authorization List and download a copy of the appropriate Prior Authorization Request Form and Fax Cover Sheet.
Verifying Member Eligibility & Benefits
To verify eligibility and benefits for SWHP members, you can register to use the SWHP Provider Portal by clicking here. If you need assistance with using the provider portal, please contact the Provider Relations Department at 1-800-321-7947, ext. 203064 or 1-254-298-3064. You can also verify member eligibility and benefits by calling the Interactive Voice Response (IVR) System at 1-800-655-7947.
If you have never billed a claim to SWHP, then you will need to complete and submit the EDI Intake Form in order to register to use the IVR.