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Provider Forms and Resources
Provider Forms | Provider Manual | Provider Reference | Newsletters and Mailings|Disease Resources Library
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Provider Forms
Provider Data Form (PDF)
SWH's standard individual practitioner credentialing form. To be submitted by each new practitioner.
W-9 Form Provider Data Form (PDF from IRS.gov)
TIN request form be submitted with Provider Data Form
PCP Assessment Form (PDF)
To be completed by PCP(or his/her proxy when signed by the PCP) when a patient becomes a SWH member. SWH provides reimbursement upon completed form receipt. A printout of the patient’s EMR may be submitted in place of form.
Payment Dispute and Adjustment Request Form (PDF)
To be used when seeking adjustment for claims in specific circumstances. Please refer to the Provider Manual for more information.
Provider Manual
Provider Manual - 2011 (PDF)
Provider Reference
Provider Quick Reference Guide (PDF)
Tip sheet providing basics on SWH billing, authorizations, pharmacy services, subcontracted vendors and more.
Sample of Remittance Advice (PDF)
September 2010
Quality Management Program Description (PDF)
Sample Member ID Card (PDF)
Newsletters and Mailings
SWH Prov Newsletter NY Spring 2010 (PDF)
Summer 2010 NY News Letter (PDF)
Winter 2010 Prov Newsletter NY (PDF)
Spring 2011 Prov Newsletter NY (PDF)
Summer 2011 Prov Newsletter NY (PDF)
Disease Resources Library
A1C for Diabetes Diagnosis (PDF)
Diabetes Month Nov 2009 (PDF)
Highlights from the ADA 69th Scientific Session (PDF)
Highlights from the ADA 70th Scientific Session (PDF)
Diabetes Feb Newsletter 2011 (PDF)
Diabetes Newsletter- August 2011 (PDF)
Last modified: 09/01/2011