Southwest Service Administrators, Inc.
Providers Online Resources
Eligibility, Claims, & Benefit Inquiry
IMPORTANT NOTICE: In order to stay in compliance and protect our member’s personal data, the legacy fax-back will be discontinued effective 8/12/19. If you have not already done so, please create a secure account here to obtain eligibility, benefits and claim information.
|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?
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:
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
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.