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- Outside El Paso1-877-532-3778
- Hours of Operation
7:00 A.M. – 5:00 P.M.
Mountain Time - En Español
Careers
Provider Forms
Download our Provider Forms Below
- 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
- Therapy Request Checklist
- STAR/CHIP Pre-Authorization Flyer EFF 10.1.2020
- 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
General Info
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P.O. Box 971370
El Paso, TX 79997-1370
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General Correspondence
P.O. Box 971100
El Paso, TX 79997-1100
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You can request the materials in other formats by calling Member Services at 1-877-532-3778.
You can request the materials in other formats by calling Member Services at 1-877-532-3778.