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Provider/Physician Notice

View the COVID-19 Telehealth and Telemedicine Policy for coding guidelines and claims submission procedures. We have also reduced our Prior Authorization Requirements.

ATTENTION: Medicaid CHIP COVID-19 Information Notices

To view all of COVID-19 related information click here.

IVR and Portals Guide

To assist you with claims processing, we've created a new guide for our Interactive Voice Response System (IVR) and provider portals. Please refer to the IVR and Provider Portals Guide for members of Scott and White Health Plan, FirstCare Health Plans, RightCare (Medicaid), and STAR and CHIP. You can find helpful information on: IVR phone numbers, Portal websites, Claims mailing addresses, and Member ID numbers

For ProvidersProvider Home Page

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Here is your go-to guide for RightCare

Provider Manual

Filled with useful information, your provider manual helps you care for your patients in the way they need care. inside you will find.

Best viewed using current versions of Google Chrome, Firefox, Safari and/or Microsoft Edge. If you are using Microsoft Internet Explorer™ (IE) or an older version of the browsers mentioned here, you may not experience the site's optimal functionality.

  • Download RightCare Provider Manual (view or print)
  • RightCare Provider Manual Table of Contents
  • Important phone numbers
  • Billing information
  • Service that require prior authorization
  • Referral information
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    Provider Information

    RightCare Provider Relations and Services Hotline (including claims questions)

    1-855-TX-RIGHT (1-855-897-4448)

    Provider Representatives

    View Provider Representatives Territory Map.

    Contracting

    Become a Network Provider

    Thanks for your interest in becoming a contracted provider. We're always looking for exceptional providers to join our growing network of physicians and hospitals. Together, we can help you give your patients—and our members—the quality, cost-efficient care they deserve. Start the application process today.

    See below for links to information about applying to SWHP and Aperture—our Credentialing Verification Organization (CVO).

    Helpful Links:

    Healthcare Providers

    Apply to join our provider network.

    Credentialing

  • Request to Add Provider to Existing Contract
  • Request to Add Facility to Existing Contract
  • Provider Information Change Form Request
  • A provider has the right to inquire about the status of an application by sending an email to: hpcredentialinggroup@bswhealth.org
  • Credentialing Verification Organization (CVO)
  • Provider Newsletters

    All the latest information regarding Medicaid and information Provider's should know. For additional information click here.

    Provider Advisory Group

    RightCare will conduct quarterly Provider Advisory Groups with network providers to address any needs and concerns from the provider population. The Provider Advisory Group will include acute care, pharmacy providers, SWHP Provider Services, Medicaid Operations staff, and the RightCare Medicaid Medical Director. SWHP will review phone calls and complaint logs to determine patterns of concern that need to be addressed. SWHP will solicit providers for participation after they have completed the contracting and credentialing process. Provider feedback will be requested on the Provider Manual, newsletters, and the RightCare website. RightCare will utilize technology to engage providers across the service area. For more information on Provider Advisory Groups, please contact RightCare Provider Relations at 1-855-TX-RIGHT (1-855-897-4448).

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    Provider Notices and Reminders

    Looking for the latest Provider News, click here.

    HHSC Notifications

    Hurricane Ida Information for Medicaid Providers

    For additional information click here.

    Important Update on COVID-19 Vaccines

    For additional information click here.

    4/01/2021 Update Enrollment and Demographic Information

    Click here.

    4/20/2020 Temporary Change in Status for Oral Immunosuppressives Drug Class

    Click here.

    4/14/2020 Claims for Telehealth Service for Occupational, Physical, and Speech Therapy

    Click here.

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    Member Rights and Responsibilities

    Click here.

    Provider Forms & Tools

    Click here.

    Texas Health and Human Services Commission (HHSC)

    Click here.

    Report Fraud, Waste, and Abuse

    Click here.

    Texas Medicaid and Healthcare Partnership (TMHP)

    Click here.

    Texas Health Steps

    Click here.

    Texas Medicaid/CHIP Vendor Drug Program (VDP)

    Click here.

    Texas Medicaid Formulary

    Preferred Drug List

    Texas Department of Family and Protective Services

    Click here.

    Provider Training

    Click here.

    Texas Health Steps Online Training

    Cultural Competency

    It is critical that RightCare providers develop a culturally competent system of care — one that acknowledges and incorporates at all levels the importance of culture and the adaptation of services to meet culturally-unique needs.

    RightCare members vary in language and culture (e.g., customs, religion, backgrounds, etc.). Our goal is to effectively serve members of all cultures, races, ethnic backgrounds, and religions in a manner that recognizes values, affirms, and respects the worth of the individuals and protects and preserves the dignity of each. We must operate at a level in which cultural knowledge is high and policies and practices are in place that produces positive results and satisfaction from the viewpoint of the culturally diverse client.

    Provider Complaints

    Filing Complaints to RightCare

    If a provider is dissatisfied with RightCare’s policies, procedures, coverage or benefit decisions or with any aspect of the member’s treatment by physicians, hospitals or other providers, he or she have the legal right to file a complaint to RightCare and/or the Health and Human Services Commission (HHSC).

    Provider can file a verbal complaint by calling Customer service at 1-855-897-4448/ TTY 771. RightCare recommends that all complaints received from providers be submitted in writing to:

    • RightCare from Scott & White Health Plan
    • Attn: Dispute Resolution MS-A4-144
    • 1206 West Campus Drive Temple, TX 76502
    • Or by email to: swhpappealsandgrievances@bswhealth.org
    • or fax to 1-254-298-3086.

    Note: Any complaints received at the wrong address will be returned to the sender.

    Provider Complaint Process to HHSC

    A provider who believes that they did not receive full due process from RightCare may file a complaint with HHSC. Providers must exhaust the complaint process with RightCare before filing a complaint with HHSC. Complaints can be submitted orally or in writing and received by HHSC at the following address:

    Provider Claim Appeal

    A claim appeal is a request for reconsideration of payment for a previously adjudicated claim. Providers who are filing an appeal of a claim decision will need to submit a copy of the Explanation of Benefits (EOB) page showing the claim in question, a claim form, and other supporting documentation including the reason for the appeal. Providers should submit one copy of the EOB for each claim to be appealed and circle which claim is being appealed. The reason for the appeal or reconsideration request may be written on the EOB or described in a separate document. All information should be printed on a single side of the copy. If the original claim was denied for incorrect information, a new CMS 1500 or UB-04 with the corrected information should be submitted as a corrected claim. Appeals must be written and submitted within 120 days from the date of disposition, which is the date on the Remittance Advice. RightCare will adjudicate all appeals within 30 days of receipt of the appeal.

    Submit all correspondence to:

    • Scott and White Health Plan
    • PO BOX 981727
    • El Paso, TX 79998-1727
    • Electronic submission through provider portal: rightcare.firstcare.com/Web/

    Note: Any complaints or appeals received at the wrong address will be returned to the sender.

    Prior Authorizations (PA)

    Click here.

    Provider Portal

    Click here.


    • The National Committee for Quality Assurance (NCQA) awarded Scott and White Health Plan an Accredited Status (Medicaid certified 03/2021) - reflecting our continuous work to fulfill NCQA requirements for consumer protection & quality improvement.