Scott and White Health Plan Prior Authorization

Scott and White Health Plan 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

• Medical-benefit prior authorization is handled by BSWHP Health Services Division, and the site states that prior authorization does not guarantee payment. For medical-benefit services/drugs, providers can submit via secure provider portal, fax, or phone for after-hours urgent admissions or when online/fax is not possible. Pharmacy-benefit drug prior authorizations are handled separately by Capital Rx, not BSWHP Health Services.
• Prior authorization requirements vary by service, plan, and whether the benefit is medical or pharmacy.
• The site states that prior authorization does not guarantee payment.
• For some services, the provider may need to check the authorization-required list or provider portal for current requirements.
• Pharmacy-benefit prior authorizations are not processed by BSWHP Health Services.

Where to verify prior authorization requirements

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

How to submit prior authorization requests

• secure provider portal

• fax

• phone (after-hours urgent admissions or if online/fax submission is not possible)

• ePA portal for pharmacy-benefit drugs (Capital Rx)

• Submission resource 1

• Submission resource 2

• Submission resource 3

Information commonly required

• prior authorization form
• cover sheet for faxed submissions
• supporting documentation as requested through the portal
• clinical information sufficient to determine medical necessity and appropriateness
• member benefit / diagnosis / requested service details

Turnaround notes and caveats

• Health Services Division accepts medical-benefit prior authorization and peer-to-peer requests during regular business hours (8 AM to 5 PM) and after hours.
• The portal is described as providing automated responses, real-time updates, status checks, documentation upload, and request updates.
• Prior authorization requirements vary by service, plan, and whether the benefit is medical or pharmacy.
• The site states that prior authorization does not guarantee payment.
• For some services, the provider may need to check the authorization-required list or provider portal for current requirements.
• Pharmacy-benefit prior authorizations are not processed by BSWHP Health Services.

Provider resources

• Provider Resources (official)
• Claims & Billing (official)
• Medical Resources (official)
• Pharmacy Resources (official)
• Commercial Provider Manual (PDF) (official)

Sources