Read the full update, click here.

The PCP Quality and Performance Improvement team has created fast and easy tip sheets to help you streamline clinic quality action items and best practices to improve health outcomes. The Quality Measure Summary (QMS) tip sheets are designed to encourage patients and providers to partner together on their care plans and address time-sensitive screenings. The QMS tip sheets can be found on the SWHR provider portal under the Quality page.

If you have questions or want more information, please contact your Provider Relationship Manager (PRM) or email [email protected].

Southwestern Health Resources (SWHR) continues to evaluate opportunities to offer group health insurance to CAP practices. As we pursue options, we kindly ask that you answer six questions to help us assess the best potential solution.

Southwestern Health Resources (SWHR) is pleased to announce an expansion to the Wellcare agreement. SWHR will be adding the Wellcare PPO product and therefore eliminating the product exclusions for UT Southwestern and Clinically Affiliated Physicians (CAP). This also adds Texas Health Physicians Group to both Wellcare HMO and PPO products effective March 1, 2022.

To read the full alert, click here.

COVID-19 Alert Disclaimer: This is the most up-to-date information as of Feb. 16, 2022. This COVID alert provides the latest information regarding product allocation and availability as well as the latest COVID-related news and updates. The key objective is to provide physicians with the most up-to-date information. Ultimately, decisions about patient care, including therapeutic options, are based on a physician’s individual medical judgment.

Read the full Pharmacy COVID-19 Alert here.

Pharmacy Update: This is the most up-to-date information at the time of publication. The Pharmacy Update is providing tips on lower cost alternatives to higher cost non-preferred prescription drugs and market events such as COVID-19. The key objective is to provide physicians with information. Ultimately, decisions about patient care, including prescriptions, are based on a physician’s individual medical judgement.

Read the full pharmacy update, click here.

The Office of Inspector General (OIG) in partnership with the DOJ has completed several investigations with findings of False Claims Account (FCA) violations. These findings don’t always end with a debarment. They may end with settlements that range from self-disclosure, CIA’s and even exclusion. Based on data from the OIG, most investigations end with no further action. In Texas there have been several investigations in the last month that have resulted findings of FCA and AKS violations. We want to take this opportunity to remind providers to inform SWHR if they are under investigation or might be barred from participation in federal programs. Failure to notify SWHR could result in termination.

SWHR ACN is required to report to CMS within fifteen (15) days when we are made aware that a provider “is under investigation or has been sanctioned by any government agency or any licensing authority, including, without limitation, the imposition of program exclusion, debarment, civil monetary penalties, corrective action plans, and revocation of Medicare billing privileges.” As a member of the SWHR CIN, you are required to report within five (5) days of becoming aware that you are under investigation or may be sanctioned or barred from participation in federal programs depending on the contract with SWHR.

If you have additional questions, please contact your Physician Relationship Manager (PRM).