Southwest Service Administrators, Inc.

Providers Online Resources

 

Frequently Asked Questions

What is the process of filing claims electronically?

Please refer to the members ID card for EDI filing information.


What are your requirements for ICD-10?

All claims for dates of service on or after October 1, 2015 must be submitted with a valid ICD-10 code; ICD-9 codes will no longer be accepted for these dates of service.


Are ICD-10 diagnosis codes required on Dental claims for dates of service on or after 10/1/2015?

No.


Why use Provider Portal?

The Provider Portal is a great benefit for provider offices. Providers can view Eligibility status, Benefit information, and/or Claim status information immediately.  To register for the Provider Portal a provider or representative will need the Provider’s Tax ID and a check number recently received from the trust fund.  If you need further assistance please contact the Customer Service Team.


What is an Audit Number and how do I obtain one?

Once a provider has used our automated systems for assistance they will receive an audit number.  A Current Audit number received within the last five business days is necessary if you need further assistance with the Customer Service team.  The Customer Service Representative will need that number to access the information in question.


Why is Accident Information needed?

Most Funds have an Accidental benefit that will cover some charges for treatment and services directly resulting from an accident. Each fund also has Subrogation and Reimbursement rights.  See Summary Plan Description booklet. Only the member can provide Accident Information to the Fund.  They can provide this information by either contacting our office to give us this information over the phone, logging into their on-line Portal sending the information via secure message, or by printing out and completing the form on the Website for the appropriate Trust Fund.  These forms can be faxed or mailed to the appropriate claims mailing address listed on their Medical ID Card.


How can I submit claims?

Providers have several convenient options for submitting claims:

  1. Submit electronically using the Payor ID# on the Medical ID Card.   (Networks may require In-Network providers to submit electronically.)
  2. Mail directly to the claims mailing address on Medical ID card (Only if the provider is not In-Network and required to submit electronically)

What do we need to provide on the claim?

Providers need to submit a clean claim with all required fields completed.

 The Top Reasons why claims could be rejected

  1. Member’s ID Number was not submitted correctly
  2. Did not use the correct Group Number from the Member’s ID Card
  3. Not having a current W9 on file
  4. Submitting with a Billing Provider Name that does not match the registered name for the Billing NPI and/or Tax ID.
  5. Submitting with a Rendering Provider Name that does not match the registered name for the rendering provider NPI.

Can claims be Faxed or Emailed directly to Southwest Service Administrators?

No. Claims are only accepted by the acceptable methods listed on the ID Card.   


Can we Fax the Medical Records, Physician RX, Updated W9, or Primary EOB?

Only Requested documents required to fully process the claim will be accepted by fax including Medical Records containing less than 15 pages, Physicians Rx, Updated W9, or a Primary EOB.


How much time should I allow for claims to be processed?

Providers should allow up to 30 days for claims to fully process. Explanations of Benefits are mailed to the Member and Provider once the claim has been processed.


What should I do if my claim is denied for payment?

Be sure to thoroughly read your Explanation of Benefits. Call the Customer Service Team if further clarification is needed after review.

 

Need to Call Us?

If you are a provider and need further assistance, you can leave a voice mail for our Customer Service Department. Please refer to the member's ID card for the appropriate phone number. Please include the necessary information listed below in your voice mail to allow one of our team members to return your call.
  1. Audit Number from our Website or Automated System
  2. Your Name
  3. Your Phone number where you can be reached
  4. The Provider Name
  5. The Provider Tax ID
  6. Subscriber’s Group Number
  7. Subscriber’s Name
  8. Subscriber’s Social Security Number
  9. The Patient’s Name
  10. Patient’s Date of Birth
  11. An explanation of the information you are looking for. If you are looking for Claim Status then we will also need the Date of Service and the Billed Amount.

Voice mail messages that are left with all of the necessary information, should expect a call from our office within one business day.