- Senior Whole Health – MA - https://www.seniorwholehealthma.com -

Provider Materials

Critical Information

Important Provider Notice: Changes to Provider Network Effective January 1, 2022

SWH NY Q4-2021 PA Code Matrix – Medicare

SWH NY Q4-2022 PA Code Matrix – Medicaid


Important Provider Notice: Fiscal Intermediary Paperwork Due 12/17/2021

  • On 1/01/2022, Tempus Unlimited will become the only Fiscal Intermediary serving the MassHealth PCA and MFP Self-Directed Waiver Programs.
  • All consumer-employers and PCS who DO NOT CURRENTLY use Tempus Unlimited as their FI must complete and return their paperwork no later than December 17, 2021. Click on the link above to download detailed information.

At Senior Whole Health of Massachusetts, we value you as a provider in our network. That’s why we work hard to provide you with the resources you need to help care for our members.

Helpful Resources

Provider Manualupdated October 2021, in accordance with Executive Order 14042, Ensuring Adequate COVID Safety Protocols for Federal Contractors

Model of Care Training Presentation

Provider Quick Reference Guide

Provider Portal Registration Guide

Skilled Nursing Facility Quick Reference Guide (SNP Snippets)

Prior Authorization Grid

SWH Referral and Authorization Grid

CAHPS Provider Tip Sheet

Flu Shot Reminder for Providers

Provider’s Guide to Billing for Vaccinations


Fraud and Waste Reporting Policy

FDR Reporting Poster

False Claims Summary Update

FDR Compliance Guide

Code Of Conduct

SWH Compliance Program

HIPAA Compliance statement


2021 Pharmacy & Prescription Drug Materials
Frequently Used  Forms

Online Request for Medicare Part D Redetermination
Online Request for Medicare Part D Prescription Drug Coverage 
Prescription Coverage Determination Form (PDF) 
Medicare Reconsideration Request Form
Medicare Redetermination Request Form
Part D Formulary (September 2021)

Part D Formulary Change Chart (September 2021)
SCO Formulary (September 2021)

Prior Authorization Criteria (September 2021)
Changes to Prior Authorization Requirements (Effective May 1, 2021)
Medical pharmacy drugs (J-Code) requiring Prior Authorization List (updated May 1, 2021)
Quick Reference Guide to High Risk Medications and their Alternatives

Provider Newsletters
Recent Provider Notices
Information Regarding Coronavirus (COVID-19)
Behavioral Health Toolkit

Magellan Healthcare manages Senior Whole Health’s behavioral health benefits. The links below provide important tools and guidance for the management of behavioral health conditions.

Magellan Toolkit
Providing Care
Substance Abuse Treatment

Prevention and Control of Seasonal Influenza with Vaccines
Clinical Practice and Preventive Health Guidelines, Resources, and Care Recommendations
HEDIS® Tip sheets