Provider Account Management

Add new facility form

Please complete this form to add a provider to your existing contract with SWHP.
Submission of this form is not an automatic approval to SWHP’s network.
We will contact you for more information or confirmation of your request.

Please complete all fields. Enter N/A if a field is not applicable.

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Once done, click the "Submit" button again.

* Group Name:
* Group NPI:
* Provider Name: (as shown on W9)
* Joined Group Date:
* Specialty:
* Provider Type:
* Board Certified:
* Tax ID:
* NPI:
* TPI Medicaid:
* Medicare:
* Phone Number:
* FAX Number:
* Email or Website:
* Contact Name:
* Contact Email:
* Contact Position/Title:
* Contact Phone:
Contact Extension
* Contact FAX
Comments/Notes
Attach File (PDF or ZIP Only)

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Success!

Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.

Please allow 30-45 days before checking on status.

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Please download, fill out, and email the SWHP Add Provider to Existing Contract Form to ensure timely handling of your request.