Scott & White Health Plan

Medical Management

• Primary Care Physician Program
  • Request for Designation as Secondary Care Physician for a Health Plan
  • Term Physician/Patient letter
  • Specialist as Primary Care Physician
  • Request for Non-PCP Specialist to function as PCP
     
• Physician's Office DME/Supplies Policy
   
• Physician Referral Processes
  • Physician Referral Network
  • Out-of-Network Referrals
     
• Forms
  • General/Medical/Surgical
  • Mental/Behavioral Health
  • SWHP S&W System Providers Technical Assessment Form (pdf)
  • SWHP S&W System Providers Technical Assessment Form (excel)
  • SWHP Non-S&W System Providers Technical Assessment Form (pdf)
  • SWHP Non-S&W System Providers Technical Assessment Form (excel)
  • Case Management forms
    • Provider Referral Form
    • Facility / Hospital Referral Form
    • Customer Service Referral Form
       
• VitalCare Utilization Management Programs
  • Health Services Division Philosophy and Goals
  • Hospitalization Procedures
  • SWHP Utilization Management Criteria - Inpatient Services
  • Outpatient Services Preauthorization
  • Forms
    • General/Medical/Surgical
    • Mental/Behavioral Health
  • Utilization Management Program Description
  • Health Care Management Guidelines
  • Interqual Criteria
  • Utilization of Services
  • Technology Assessment Program
    • SWHP S&W System Providers Technical Assessment Form (pdf)
    • SWHP S&W System Providers Technical Assessment Form (excel)
    • SWHP Non-S&W System Providers Technical Assessment Form (pdf)
    • SWHP Non-S&W System Providers Technical Assessment Form (excel)
  • Complex Case Management
  • Disease Management/Condition Management
  • Cooperative Care (Medical Home)
  • Other VitalCare Resources
       
• Medical Policies
   
• Frequently Asked Questions