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Providers ยป Claims & Billing

Electronic Claims

Electronic Claims

SWHP strongly encourages electronic claim submission. We accept direct EDI submissions or Clearing house submission. There is no cost to providers for direct EDI submission.
Providers who bill electronically can expect:

  • More timely payments
  • Faster responses regarding claim submission status
  • Lower overhead costs
  • More control over claim data accuracy

Scott & White Health Plan currently accepts electronic claims via the Availity Clearinghouse. The Availity system is simple to use. It integrates into the software systems typically used in most physician offices and hospitals around the state.

  • There is no cost to providers for submitting claims. However, medical software vendors may charge a fee for installation and maintenance of system enhancements that support claims transmissions. Contact your software vendor for more information. Fees are paid by insurance carriers to Availity to support the claim submission costs.
  • Contact your office computer software company or system vendor to see if they participate or call the Availity Help line at 800-282-4548 or visit their website at availity.com.
  • Providers must use their National Provider Identifier (NPI) number when submitting claims through Availity so proper provider identification can be made.
  • When submitting claims, use the Scott &White Health Plan payer number -88030.
  • Both UB-04 and CMS-1500 claims forms are accepted electronically.
  • Providers are strongly urged to work daily their accepted/rejected reports from Availity to determine if any claims were rejected by SWHP.
  • Patient member identification numbers must be complete (and include the two-digit suffix at the end) for a claim to be accepted electronically.
  • Non-contracted providers need to fill out an EDI Intake Form and an EDI Authorization Form (hyper-link to the forms) before filing claims to SWHP for the first time. The EDI Intake Form is for our Provider Relations team to enter your provider information to our claims adjudication system. The EDI Authorization Form allows you to sign up to submit and receive certain HIPPA transactions.