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TRS Member Handbook - Billing

SWHP Billing

Claims

Claims are usually submitted by the provider of service to SWHP on your behalf and you are responsible for giving them your insurance information at the time of service. When you receive services out of the SWHP service area, the provider may request payment in full at the time of service. You will need to submit a copy of the medical expenses (itemized bill showing paid in full), to SWHP. The following information is needed to process your claim:

  • A copy of the bill
  • An itemized copy of the services which includes valid procedure and diagnosis codes
  • Explanation of why services were received outside the SWHP network
  • The date of service
  • The name of the patient
  • The name of the contract holder
  • The enrollee identification number
  • Written proof of the payment (copy of the canceled check, receipt, etc.)
  • Explanation of Medicare Benefits (if applicable)

Please forward the claim to the following address:

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

If you have any questions about how to submit your claim or other claims questions, please call SWHP at (800) 321-7947 or (254) 298-3000 between 8:00 a.m. and 5:00 p.m.

Claims Status Notification

After SWHP has received a claim from the provider or from you for reimbursement, additional information may be needed to process the claim. You will be notified with a Claims Status Notification by mail defining what additional information is needed to complete the processing of your claim. Please read the notification carefully to see what action, if any, is needed from you. If you have any questions regarding a Claims Status Notification, please contact SWHP at (800) 321-7947 or (254) 298-3000 between 8:00 a.m. and 5:00 p.m.

Coordination of Benefits

You may be eligible for Coordination of Benefits if you have more than one health coverage plan. Coordination of Benefits requires insurers to share the responsibility for paying for services they both cover. The primary insurer pays first; the secondary insurer pays the balance (provided the balance is not more than the secondary carrier would have paid under the provider's contract and the member's contract benefits).

If you have any questions, or if you would like to see if you are eligible for Coordination of Benefits, please call SWHP at (800) 321-7947 or (254) 298-3000.

Workers' Compensation

If you see a SWHP network physician about an injury that occurred while you were on the job, you must report this to the clinic at the time of your visit. This allows your charges to be filed with the appropriate Workers' Compensation insurance carrier.