Scott and White Health Plan Prior Authorization

Scott and White Health Plan prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

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