Scott & White Suspends Prior Auth Requirements for Home Health

March 2020

Scott and White Health Plan is committed to supporting access to care and easing transitions for our members as they receive services from health system providers and facilities during this national emergency.

To help support the efforts of caregivers, Scott and White Health Plan is making temporary changes to reduce the administrative burden for providers and facilities who are coordinating and delivering health care services for our members.

The following changes are effective immediately:

  • We are suspending prior authorization requirements for admissions to in-network Skilled Nursing Facilities for all lines of business through May 31, 2020*. We are changing to a notification requirement.
    • Medical necessity is required, using Medicare criteria (Texas Medicaid criteria for RightCare members).
    • Facilities must notify us within 4 days of admission, including provision of clinical records, at which time SWHP will perform an admission review.
    • Length-of-stay reviews will still apply.
  • We are suspending prior authorization requirements for starts of in-network Home Health Care Services for all lines of business through May 31, 2020*. Notification is still required for claims payment. Medical necessity is still required. Scott and White Health Plan will perform length-of-stay reviews for services needed more than 10 days.
  • Prior authorization is not required for COVID-19 testing and COVID-19 testing-related visits.

Please check our website for up-to-date information from Scott and White Health Plan related to COVID-19.

*Note that any existing plan benefit limits will continue to apply to the delivered services

Thank you,
Health Services Department, Scott and White Health Plan


Home Health Billing to Go, Inc. is now offering
full service PCR Clinical Review. Service includes:
Review of clinical record for PCR compliance,
submission of PCR request and/or billing services.
Please contact us at
pcrinfo@homehealthbillingtogo.com
for additional information.