An authorization is required for all inpatient admissions, outpatient procedures, all out- of-area and out-of-network services and other services as defined by El Paso Health, with the exception of family planning services. For a list of procedures requiring authorization please refer to the Pre-Authorization Flyer.
You can find all the necessary forms in our Provider Forms page.
If you have a complaint, you can submit it to the El Paso Health Provider Care Unit at 915-532-3778 ext. 1504 or toll free at 1-877-532-3778 ext. 1504. You can also send us an email at Complaints_Appeals_Department@elpasohealth.com or send us a fax at 915-298-7872.
The HHSC mailbox for provider complaints is: HPM_Complaints@hhsc.state.tx.us.
Providers can submit a claim appeal by contacting us at:
Phone: 915-532-3778 ext. 1504 or toll free at 1-877-532-3778 ext. 1504
Providers Appeals Due to Retro-eligibility
Please contact your Provider Relations Representative at 915-298-7198 x 1507 to initiate an appeal if you disagree with a recoupment due to retro-eligibility changes.
In the event a Provider becomes aware of an overpayment prompt notification shall be reported to El Paso Health. Overpayments shall be returned within 60 days from date of reporting to El Paso Health. In the event overpayment is not received, El Paso Health will proceed to recoup the overpayment from the provider. For reporting please utilize you web portal account quick links Provider Overpayment Reporting tab, email Provider_Overpayments@elpasohealth.com or contact the Provider Care Unit (PCU) at 915-532-3778 x 1504 or toll free 1-877-532-3778.
How to Provide Cultural Sensitive Care
Proficiency in cultural competency is demonstrated when Providers acknowledge a Member’s point of view of his/her healthcare and integrate that awareness in the delivery of medical services. El Paso Health facilitates Provider orientation sessions to promote our Cultural Competency Plan and educate network Providers about culturally competent services to avoid disparities in the delivery of medical services to the diverse populations of the El Paso SDA.
By contractual agreement, all Network Providers are required to adhere to the standards of the Americans with Disabilities Act (ADA). Our Provider Relations Representatives conduct credentialing site visits as well as quarterly visits to Primary Care Providers, Obstetricians and Behavioral Health Providers, and annual visits to all other specialists, to ensure Providers’ locations are accessible to Members with disabilities. El Paso Health’s Cultural Competency Plan is made available to El Paso Health Network Providers in written form, when requested. Our Provider Manual includes a section on cultural competency.
Provider Advisory Group
Provider Advisory Group discussion is held on a quarterly basis via the Utilization Management Committee Meeting. The provider panel provides guidance for enhancements to maintain and continually improve El Paso Health’s service to the provider network, and to ensure provider satisfaction with health plan processes. To participate in the Provider Advisory Group, please call us at 1-877-532-3778.