Providers & ASAPs

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Member Eligibility

NewMMIS and NEHEN online tools remain the most efficient way to check member eligibility.

Advantage of using NEHEN and NewMMIS online tools

  • Prompt, 24/7 access
  • Unlimited number of inquiries
  • Ability to confirm single dates of service and date ranges
  • Can print eligibility confirmation for your records

NewMMIS (formerly REVS)

  • Log into Provider Online Service Center (POSC)*, click Manage Members/Eligibility, and look up patient by SSN or name and DOB.
  • In the List of Managed Care Data (for MCO) section, SWH will be listed under MCO Name.
  • Free registration for MassHealth Providers.
  • For registration and other information:
      - www.Mass.gov/masshealth*
      - 800-841-2900 (this number may also be used to access the IVR system)

NEHEN - New England Healthcare EDI Network

  • For SWH members, log in and select Medicaid as payer. SWH is under Managed Care Coordinator within the Additional/Alternate Payer section.
  • Available at no cost to NEHEN members.
  • For NEHEN membership and other information:
      - www.NEHENNet.org*
      - 781-290-1290

If you do not have access to neither NEHEN nor NewMMIS online tools, you may be able to use the NewMMIS Interactive Voice Response (IVR) for up to 3 patients per call. The NewMMIS IVR telephone number is 800-841-2900.

If you are not eligible to have a NewMMIS account, you may fax requests to Provider Relations at 617-494-5599. Please use the SWH Eligibility Confirmation fax form.

For member benefit questions, please refer to the SWH EOC and Summary of Benefits. If you must call SWH Provider Relations for clarification on benefit coverage, we suggest that you confirm eligibility first through one of the means listed above.

For authorization information, please refer to the SWH Referral and Authorization grid. If you must call SWH Provider Relations to for clarification on prior authorization, we suggest that you confirm eligibility first through one of the means listed above.

Should you have additional questions after using the above resources, please contact SWH Provider Relations at 888-794-7268.

* Please note: By clicking on this link you will be leaving the SWH web site.

Last modified: 09/15/2010