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Important updates

Effective Immediately

Purpose of this notice is to educate and inform all providers on Clinical Laboratory Improvement Amendments (CLIA) certificate requirements in order for your claims to be processed correctly.

CLIA is required for all facilities or providers that examine "materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of any disease or impairment of, or the assessment of the health of human beings." If a facility or provider performs tests for these purposes, they are considered a laboratory and must obtain a CLIA certificate in accordance with CLIA laws and regulations.

Plan is requesting all laboratory providers to please submit your most current and updated CLIA certificate.

Laboratory servicing providers who do not meet the CLIA billing requirements will not be reimbursed.

You may submit these via email to hpcliaupdate@bswhealth.org.

If you have any questions you can contact our Provider Services Center at 844.633.5325.

To assist you with claims processing, refer to the IVR and Provider Portals Guide.

As we continue transitioning to a new claims system, please verify eligibility by using the portal listed on the member's ID card. Most members can be verified through swhpprovider.firstcare.com. Otherwise, please visit portal.swhp.org/providerportal.

  • Testing and Vaccination: COVID-19 testing and vaccination are available to health plan members at zero out-of-pocket cost. Click here for more information and benefit updates.
  • Telehealth and Prior Authorization Information: View the COVID-19 Telehealth and Telemedicine Policy for coding guidelines and claims submission procedures. We have also reduced our Prior Authorization Requirements.
  • Hospital Without Walls: HHSC adopted emergency rules in response to the state of disaster declared in Texas and the U.S. 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. Learn more.

We've teamed up with Cricket Health to help kidney care specialists enhance the quality of life for their patients. Cricket Health's evidence-based approach can help you lower costs and improve patient engagement and key clinical outcomes for eligible members living with chronic kidney disease (CKD) or end-stage kidney disease (ESKD). To learn more, visit Cricket Health or read more here.

We teamed up with Landmark Health to provide BSW SeniorCare Advantage members with access to home-based care. View a summary of services Landmark provides, visit Landmark's website, learn more about program information and read the FAQ. Call Landmark to schedule a visit at 833.874.2581 (TTY: 711).

  • Health Talk: View this month's featured areas of our health talk:
    • Sleeves Up, Texas View the Flu Awareness flyer that can be distributed to your patients for more information.
  • Clinical Practice Guidelines: View the Quality Improvement: Clinical Guidelines which are resources intended to optimize patient care.
  • Accessibility of Services Requirements: Primary Care Providers (PCPs), Specialty Providers and Behavioral Health (BH) Providers are required to provide members timely access to care. For information on appointment and access standards and after-hour requirements for practitioners view the Accessibility of Services Requirements.

Join Our Network

Interested in becoming a Baylor Scott & White Health Plan (BSWHP) contracted provider? We'd love to have you as a part of our growing network. We work with more than 36,000 providers and 4,000+ facilities in Texas to provide a high-level continuum of care, every day. And there's an even stronger commitment to providing you with digital tools that improve the patient journey. Start the application process today.

Healthcare providers

Apply to join our provider network.

Pharmacy providers

Apply to become a Commercial or Medicare pharmacy network provider by contacting Optum Provider Relations at Provider.Relations@optum.com or 877.633.4701.

Account Management 

Contact us

Our Provider Relations Team is here for you, no matter where you're located. If you have questions or need support, visit the Contact Us page and view the Provider Relations Representative Territory map to find the right contact.

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