Methods of Claims Submission
for Providers of Service

Electronic Claims

• Scott & White Health Plan (SWHP) encourages all providers to submit claims electronically.
• SWHP currently accepts electronic claims via the Texas Health Information Network (THIN) clearinghouse.
• The THIN 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 THIN to support the claim submission costs.
• Contact your office computer software company or system vendor to see if they participate or call the Texas Health Information Network Help line: 972-766-5480.
• Providers must use their SWHP assigned provider number when submitting claims through THIN so proper provider identification can be made. For questions regarding your SWHP assigned provider number call our Health Plan offices at 254-298-3000 or 1-800-321-7947 and ask for the claims department.
• When submitting claims, use the SWHP payer number – 88030.
• Both UB92 and HCFA1500 claims forms are accepted electronically.
• Providers are strongly urged to work daily their accepted/rejected reports from THIN to determine what claims were not accepted 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.
• Only primary claims are accepted electronically. Secondary claims must be submitted via paper with the appropriate EOB from the primary payer attached so proper claim adjudication may occur.

Paper Claims

• Paper claims are accepted on standard claim forms (UB92 and HCFA1500).
• Claim forms must be typed or computer generated to insure readability. Handwritten claim forms will be rejected and returned to the provider.
• Claim forms should be readable and cannot contain marked-through or whiteout information.
• Claim forms must contain the necessary data elements specified in the Texas Department of Insurances regulations regarding clean claim submissions.
• For routine filing, Scott & White Health Plan will not accept FAX copies of claim forms due to difficulty in reading faxed claim forms.
• Paper claim forms should be submitted to the following address:

Scott & White Health Plan
Attn: Claims Department
2401 S. 31^st St.
Temple, TX 76508

Duplicate Submissions

Duplicate claims submissions are discouraged. Adequate processing time should be allowed and a status check performed before another claim is submitted. Multiple duplicate submissions create processing and payment problems for both the payer and provider of service.

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