Baylor Scott & White Insurance Company Prior Authorization

Baylor Scott & White Insurance Company publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.

At a glance

• Prior authorization is required for certain services and does not guarantee payment. BSWHP uses a provider portal/GuidingCare workflow for authorizations; providers initiate the request in the current portal and are transferred to GuidingCare to complete it. Requirements vary by line of business and service category, and medical-benefit drugs are handled separately from pharmacy-benefit drugs.
• Prior authorization requirements vary by service, benefit type, and line of business.
• Prior authorization does not guarantee claim payment.
• Medical-benefit drugs and pharmacy-benefit drugs use different request paths.
• The official site references a separate list of services requiring prior authorization, which should be checked before submission.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3
• Verification resource 4

How to submit prior authorization requests

• Provider portal / GuidingCare single-sign-on workflow

• Phone support via Provider Service Center / Customer Service where applicable

• Separate process for pharmacy-benefit drug requests

• Separate process for medical-benefit drug requests

• Submission resource 1

• Submission resource 2

• Submission resource 3

Information commonly required

• Member name
• Member date of birth
• Member number
• Requesting provider name
• Requesting provider NPI
• Dated signature
• Rendering provider name
• Rendering provider NPI
• Rendering provider tax ID
• Group NPI, if applicable
• Requested CPT/HCPCS/CDT code(s)
• Start and end date(s)
• Quantity of service units requested
• Supporting clinical documentation showing medical necessity

Turnaround notes and caveats

• The provider site states the authorization portal provides automated responses and real-time updates and is expected to shrink turnaround times.
• If a request is missing essential information, it will not be processed and a new request must be submitted.
• Prior authorization requirements vary by service, benefit type, and line of business.
• Prior authorization does not guarantee claim payment.
• Medical-benefit drugs and pharmacy-benefit drugs use different request paths.
• The official site references a separate list of services requiring prior authorization, which should be checked before submission.

Provider resources

• Provider Resources (official)
• Claims & Billing (official)
• Self-Service Portal (official)
• Portal Login (official)
• Contact Us (official)
• Commercial Provider Manual PDF (official)
• Prior Authorization List PDF (official)
• Pharmacy Resources (official)

Sources