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Home
About Us
– Board of Directors
– El Paso Health Leadership
Members
– Provider Directories & Member Handbooks
– Value-Added Services
– How Do I Qualify?
– Health Risk Assessment
– FIRSTCALL Medical Advice Infoline
– Important Information Regarding Zika
– HHSC News
– How to Submit a Complaint
Providers
– Provider Forms
– Prior Authorizations
– Prior Authorization Tool
– Contracting and Credentialing
– Out of Network Provider Enrollment
– Provider Enrollment
– Case Management Referral Form
– Texas Health Steps Information for Providers
– Clinical Practice Guidelines
– HHSC Updates
Programs
– STAR PROGRAM
– CHIP PROGRAM
— CHIP PERINATAL
— CHIP PERINATAL NEWBORN
– HealthCARE Options
Find a Provider
– Find a Pharmacy
– Vision Directory
Contact Us
Volunteer
Provider Forms
Download our Provider Forms Below
Claim Forms
Corrected Claim Form
Clean Claim Elements
CMS 1500 Claim Form Instruction Manual
New CMS 1500 Guidance
Complaints and Appeals Forms
Fair Hearing Request Form English
Fair Hearing Request Form Spanish
Request for a Review by an Independent Review Organization
Request for a Review by an Independent Review Organization – Spanish
Credentialing Packet Forms
DME Supplies Form
Demographic Form
W9 Form – Request for Taxpayer Identification Number and Certification
Credentialing Checklist for Organization/Facility
Credentialing Application for Organization
Secondary Locations for Organization
Credentialing & Re-Credentialing Checklist for Physician
Texas Standardized Credentialing Application
Health Services Forms
Therapy Request Checklist
Listing of Services Requiring Prior Authorization
Texas Standard Prior Authorization Form for Health Care Services
Behavioral Health Prior Authorization Form
Prior Authorization Form – Out of Area Inpatient
Prior Authorization Form – NICU
IUD Abandoned Unit Return Form
Case Management Referral Form
Members Services Forms
Authorization to Disclose information to PCP
1027 Medicaid Eligibility Form
Specialist as a PCP Request Form
Misc. Forms
EFT Form
El Paso Health Payer Identifications
Electronic Remittance Advice (835) Request Form
HealthX Fax System
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