- Call us at:915-532-3778
- 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
- Pre-Authorization Flyer – STAR/CHIP EFF 10.15.2018
- 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
Home
About
Members
Providers
Programs
Find a Doctor
Events
Contact Us
Sitemap
Paper Claim Submissions
El Paso Health - Claims
P.O. Box 971370
El Paso, TX 79997-1370
Important Info
Fraud & Abuse
Texas Office of Inspector General
Privacy Statement
Notice of Privacy Practices
Non-Discrimination Policy
HIPAA/HITECH
CHIP Evidence of Coverage w Schedules A-E
CHIP Perinate Evidence of Coverage w Schedule
CHIP Perinatal Newborn Evidence of Coverage w Schedule
General Correspondence
P.O. Box 971100
El Paso, TX 79997-1100
©Copyright 2014 – El Paso Health
Website by CultureSpan Marketing