We Help You to Help Your Patients.
Information Regarding Coronavirus (COVID-19)
Provider Correspondence 3/24/20: SWH will implement the following policy from March 23 - June 23, 2020 (PDF)
Provider Correspondence 3/23/20: Please share this with your admissions department, or whomever conducts Prior Authorization reviews at your facility (PDF)
Provider Correspondence 3/16/20: Clarity around coverage and clinical issues related to COVID-19 (PDF)
Provider Correspondence 3/16/20: A message from MassHealth (PDF)
Model of Care Training
The Centers for Medicare & Medicaid Services (CMS) requires Special Needs Plans (SNPs) to provide initial and annual Model of Care (MOC) training to our network providers and all out-of-network providers seen by our members routinely. This training ensures providers have knowledge of the Senior Whole Health population and our Model of Care.
Senior Whole Health Model of Care (PDF)
Please complete the 2020 training by October 31, 2020. Click here to complete.
COVID-19 Provider Webinars: Please click here to view information & materials for past as well as upcoming Provider webinars.
How to build resilience and adaptive skills during the pandemic Tips for caring for the emotional health and wellness of you and your family during these uncertain times. Learn more. If you missed the live webinar, the recording is posted here.
Senior Whole Health now offers Electronic Remittance (ERA) and Electronic Fund Transfer (EFT). If you are currently enrolled with Change Healthcare ERA or EFT you should be seeing your payments electronically. If you are not enrolled, you can switch from paper to electronic payments over the phone, online, through the mail or via fax.
Senior Whole Health is dedicated to providing our members with the best care possible and keeping them healthy and independent.
Senior Whole Health Nurse Care Managers are assigned to each member. These nurses help plan, organize and arrange services to effectively coordinate medical, behavioral, pharmaceutical, and social and community based services with the providers, local elder services agency and others involved in our members' care. Senior Whole Health Nurse Care Managers are available by phone 24/7 to both our providers and members in order to best facilitate treatment.
The result is a comprehensive, team-based care plan that anticipates and adapts to the changing needs of each member, striving to keep them secure, independent and living in the comfort of their own home.
Click here to view the Senior Whole Health Provider Manual (PDF).
Senior Whole Health's Dental Provider Manual is available through SKYGEN USA’s Provider Portal.
Click here to view Senior Whole Health's HEDIS® Measures of Focus (2020) (PDF).
Click here to view Senior Whole Health's HEDIS® Tips for Quality Care (PDF).
Enroll in Medicare as a Provider Now! Learn more.
Visit the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) to securely and electronically submit and manage Medicare enrollment information.
First Tier, Downstream, and Related Entities (FDR) Compliance Guide & Attestation: Click here to review and complete the FDR Annual Compliance Attestation
Click here to view information about False Claims Act laws.Senior Whole Health encourages you to report fraud or suspected fraud by calling the SWH Fraud Hotline at 1-800-341-4915, our anonymous compliance hotline at 1-800-915-2108 or the Main SIU Hotline at 1-800-755-0850.
Click here to view Senior Whole Health's Fraud Waste and Abuse Policy.