Providers
You can contact us at 915-532-3778 or toll free at 1-877-532-3778 for STAR or toll free at 1-833-742-3127 for STAR+PLUS. Provider Relations Department Representatives can be reached during the hours of 8:00 a.m.– 5:00 p.m. Mountain, Monday thru Friday.
To join our network, visit our Contracting and Credentialing page.
Click here to visit the Texas Medicaid and Healthcare Partnership website.
Click here to visit the Texas Health and Human Services Commission website.
Contact Provider Relations for:
- Changes in address locations
- Name changes
- Billing company changes
- NPI/TPI updates
- Phone and fax updates, etc.
- Any changes you consider we may need in order to update our system and your records.
Provider E-News Updates
Subscribe to El Paso Health’s Provider E-news Updates.
E-News may include, but is not limited to:
- Provider Trainings/ Orientations
- El Paso Health Policy Updates
- Weekly Memorandums
Provider Updates
- Dec 6.2024 – In Lieu of Services
- Dec 5.2024 – Revalidation Due Date Extension and Retroactive Enrollment Period Effective Dates
- Dec 3.2024 – TMPPM Language Update for Certain HTW Telehealth Services Effective Dec. 1 2024
- Dec 3.2024 – Wegovy Coverage and Implementation of Clinical Prior Authorization for Medicaid
- Nov 20.2024 – EPH PR- Electronic Visit Verification (EVV) Alternative Device Reduction Schedule.pdf
- Nov 19.2024 – Claims Check run schedule for Thanksgiving Week
- Nov 13.2024 – Prior Authorization Criteria for Anktiva Effective Nov. 1 2024
- Nov 1.2024 – 2024-2025 Synagis Flyer
- Oct 15.2024 – EVV Policy Handbook Revisions Effective September 12 2024
- Oct 15.2024 – In Lieu of Services.pdf
- Oct 09.2024 – EPH PR-Chng in Prfrrd Drg Lst Stts for Gnrc Sldnfl Orl Sspnsn Tks ffct Sept. 25
- Oct 09.2024 – EPH Notice_HHSC to Remove Oxbryta Products from all Formularies as of Oct. 10, 2024
- Oct 09.2024 – Notice_EVV Compliance Grace Period Ends Dec. 31
- Oct 09.2024 – RSV Vaccine Procedure Code 90683 to Become a Benefit of Texas Medicaid Effective October 1 2024.pdf
- Oct 08.2024 – Enfamil Gentlease Enfamil A.R and Enfamil Reguline Possible Shortages.pdf
- Oct 04.2024 – Subscripe to EPH Providers E-News Update
- Oct 04.2024-VEPH Memo_Some COVID-19 Vaccine Procedure Codes No Longer a Benefit of Texas Medicaid & CHIP Effective Oct. 1
- Sept 26.2024-VDP Changed PDL Status for Blucocorticoids Inhaled Drug Class Effective Dec. 15 2023
- Sept 20.2024.Notice_HHSC to Begin Surveying AFC Home Providers for SFY 2023
- Sept 20.2024.Change in Preferred Drug List Status for Glucocorticoids Inhaled Drug Class Takes Effect August 22
- Sept 05.2024.El Paso Health STAR+PLUS Continuity of Care Transition Process for EPH Members
- Aug 18.2024.COVID-19 Vaccine and Vaccine Administration Medicaid and CHIP Updates Effective October 1 2024
- Aug 18.2024.Sports Physical for STAR and CHIP members
- Aug 13.2024.Genetic Services Biomarker Testing Benefits for Texas Medicaid Effective September 1 2024
- Aug 8.2024.CHIP MCOs Reinstatement of CHIP Co-pays for COVID-19 services
- Aug 8.2024.Home Telemonitoring Services Adding Federally Qualified Health Centers and Rural Health Clinics as Providers, updated
- Aug 8.2024.UPDATE – Enfamil Gentlease Enfamil A.R and Enfamil Reguline possible shortages
- Aug 2.2024.Psychosocial Care Provider Flyer
- Jul 19.2024.Fiscal Year 2025 Enhancement for Attendant Compensation- Request for Participation
- Jul 17.2024.Enfamil Reguline 12.4oz Powder Limited Availability in Retail Stores Until Mid-July 2024
- Jul 15.2024.Update to Smallpox and Mpox Vaccine Reimbursement for Texas Medicaid
- Jun 25.2024.EP-PR-Reminder about EVV Home Phone Landline Requirements.pdf
- Jun 17.2024.Waive Timely Filing of Electronic Visit Verification (EVV) Service Claims Impacted by the VMUR Hold 6.14.24
- Jun 17.2024.Drugs Added to Medicaid CHIP Formularies on June 6 2024
- Jun 06.2024.Calendar Year 2024 EVV Proprietary System Request Form Submission Deadline July 15 2024
- May 31.2024.Information for Medicaid Providers – Upcoming Changes to STAR+PLUS
- May 30.2024.Hepatitis C Prescriber Letter – Texas Medicaid HepCure
- May 30.2024.EVV Compliance Grace Period Extended for Personal Care Services to Dec. 31 2024
- May 30.2024.National Drug Codes Added to Medicaid CHIP Formularies on May 8 and May 10 2024
- May 16.2024.Change in Preferred Drug List Status for Lincosamides-Oxazolidinones-Streptogramins Drug Class Effective May 6 2024
- May 16.2024.Waive Timely Filing of Electronic Visit Verification (EVV) Service Claims Impacted by the VMUR Hold
- May 16.2024.Program and Service Requirements Schedules Available in EVV System.pdf
- Apr 26.2024.EVV Alternative Device Phase-Out Schedule for Public Comment- Due by May 15
- Apr 26.2024.Updates to the EVV Visit Maintenance Processes Hold for Dates of Service Prior to Go-Live Date
- Apr 25.2024.Chikungunya Virus Vaccine Is Now a Benefit of Texas Medicaid
- Apr 25.2024.Vaccine Services Procedure Code 90623 is Now Available Through TVFC Effective April 1 2024
- Apr 25.2024.Prior Authorization Criteria for Adzynma (Apadamtase alfa) and Pombiliti (Cipaglucosidase alfa-atga)
- Apr 16.2024.Reminder_LPC and LMFT Providers Must Enroll in Medicare Effective March 1, 2024
- Apr 16.2024.Newly Required PDMP Data Information for CMS Annual Drug Utilization Review Survey for Federal Fiscal Year 2024
- Apr 12.2024.EVV Home Health Care Services (HHCS) Service Bill Codes Table Now Available
- Mar 29.2024.Cyberattack-Change Healthcare Incident Impact and Options
- Mar 29.2024.New EVV Visit Transaction Rejection Codes to Begin April 1
- Mar 22.2024.Change in PDL Status for Antivirals Oral Drug Class Effective March 7
- Mar 22.2024.2023-24 RSV Season and Synagis Prior Authorization Ended March 15 For All Regions
- Mar 22.2024.Updates to HHAeXchange Training Resources for EVV Program Providers and FMSAs
- Mar 22.2024.EVV Claims Matching Resumes April 1 2024; Unmatched EVV Claims will Deny for Payment
- Mar 14.2024.Omnipod 5 Added to Medicaid CHIP Drug Formularies On Feb. 22
- Mar 12.2024.Change in Preferred Drug List Status for Immunosuppressives Oral Drug Class Takes Effect Feb.12
- Feb 15.2024.Updates to Vaccine Administration Procedure Code M0201
- Feb 9.2024.EVV Claims Matching Bypass from Jan 1 to March 31
- Feb 6.2024.Hepatitis C Educational Webinar For Prescribers Occurs March 6 2024
- Feb 6.2024.Reminder HEDIS SEASON
- Jan 25.2024.RSV Monoclonal Antibody Nirsevimab is a Benefit of Texas Medicaid and CHIP
- Jan 25.2024.Provider Type and Places of Service Update for Procedure Code 96372
- Jan 16.2024.Pfizer Oral COVID-19 Drug Paxlovid Added to Formulary.pdf
- Jan 05.2024.EPH-PR-UPDATE OB_GYN Prior Authorization No Longer Required for certain Genetic Testing
- Jan 02.2024.Diabetic Equipment and Supplies-Home Health Policy Update Effective Feb. 1 2024
- Dec 20.2023.RSV Vaccine Procedure Code 90678 is Now a Benefit for Pregnant Individuals Effective October 1 2023
- Dec 14.2023.EVV Program Providers and FMSAs Must Download Visit Data by Dec.22
- Dec 14.2023.Change in Preferred Drug List Status for Glucocorticoids Inhaled Drug Class Takes Effect Dec. 15
- Dec 14.2023.Coverage of Vyjuvek Begins Jan. 2024; Prior Authorization Effective Feb. 2024.pdf
- Dec 14.2023.Coverage of Adstiladrin Begins Jan. 2024; Prior Authorization Effective Feb. 2024
- Dec 12.2023.Coverage of Roctavian Begins Jan 2024; Prior Authorization Effective Feb 2024
- Dec 11.2023.Complete EVV Visit Maintenance and Submit VMURs Before Losing Access
- Dec 08.2023.Memo CLIA Guidance
- Nov 30.2023.EVV Cures Act Home Health Care Services (HHCS) Onboard Now.pdf
- Nov 29.2023.HHAeXchange Electronic Visit Verification (EVV) Training Resources
- Nov 28.2023.Change in Preferred Drug List Status for the Macrolides-Ketolides
- Nov 17.2023.Thanksgiving Holiday Office Closure and Check Run Schedule
- Nov 15.2023.Telemedicine and Telehealth Benefit Updates for Rural Health Clinics
- Sept 25.2023.2023-2024 Synagis Season
- Sept 22.2023.EVV Onboard with HHAeXchange
- Sept 22.2023.Qualifications and Ordering an EVV Alternative Device Policy
- Jul 31.2023.Texas Facility Credentialing Application to be Submitted Directly to Verisys
- Jul 28.2023.REMINDER Client Access to Mosquito Repellents Available Through Pharmacy
- Jul 28.2023.EPH-PR-Therapy Re-Evaluation Changes. 07.28.2023.pdf
- Jul 19.2023.EPH-PR-2021 Dashboard-CIS Flu-Flyer.pdf
- Jul 14.2023.COVID-19 Vaccine Administration Procedure Codes Are Now Benefits of Medicaid and CHIP
- Jun 15.2023.OB_GYN Prior Authorization No Longer Required for certain Genetic Testing
- May 30.2023.COVID-19 Vaccine Administration CPT code 0174A is a Benefit of Medicaid and CHIP
- May 30.2023.Alert Inactive NPI in NPPES Cause for Medicaid Disenrollment
- May 30.2023.DME Prior Authorization for Incontinence Supplies
- May 30.2023.EPH-PR-PDL Status Change Smoking Cessation Drug Class Effective 05.30.2023
- May 16.2023.PDL Status Change Smoking Cessation Drug Class Effective 05.16.2023
- May 12.2023.Infection Control Supplies CPT S8301 No Longer a Benefit
- May 01.2023.Maternal Depression Screening
- May 01.2023.EPH-PR – TCM_MHR Removal of DOS Span CORRECTION
- Apr 18.2023.Maternal Depression Screening
- Apr 18.2023.REMINDER A and A BH Secret Shopper Calls
- Apr 11.2023.COVID-19 Vaccine Counseling Procedure Code G0315 Now a Benefit
- Apr 11.2023.PHE Ends May 11 2023_Update Member State Fair Hearing Process
- Mar 28.2023.Multiple COVID-19 Flexibilities for Services Ending.03.28.2023
- Mar 28.2023.PHE Ends May 11 2023_ Update Member State Fair Hearing Process
- Mar 28.2023.PHE Ends May 11 2023_CHIP Co-Pays to Resume May 12 2023
- Mar 28.2023.PHE Ends May 11 2023_Update Provider Re-enrollment Extensions
- Feb 21.2023.Reminder_PCP Provider Performance Improvement Projects(PIPs)
- Feb 16.2023.CLIA Certification Required for Claims
- Feb 1.2023.Updated COVID 19 Waiver of CHIP Co Payments_Extension through April 30 2023
- Feb 1.2023.Updated COVID_19 Telemedicine,Telehealth & Telephone Services (Medical Services)_Extension thru April 30, 2023
- Jan 27.2023.Diabetic Equipment and Supplies Benefits Change for Texas Medicaid
- Jan 27.2023.COVID-19 Vaccine Administration Procedure Codes 0164A and 0173a are Now Medicaid and CHIP Benefits
- Jan 20.2023.Reminder SHP Analytics Provider Survey
- Dec 27.2022.Reminder Happy Birthday Postcards
- Dec 22.2022.Prohibition of Cost Sharing for COVID-19 Vaccine Treatment and Testing Services
- Dec 2.2022.Updated COVID 19 Waiver of CHIP Co Payments_Extension through January 31, 2023
- Dec 2.2022.Updated COVID_19 Telemedicine, Telehealth and Telephone Services (Medical Services)_Extension thru January 31, 2023
- Nov 21.2022.Thanksgiving Holiday Office Closure and Check Run Schedule
- Nov 03.2022.Updated COVID 19 Waiver of CHIP Co Payments_Extension through November 30, 2022
- Nov 03.2022.Updated COVID_19 Telemedicine, Telehealth & Telephone Services (Medical Services)_Extension thru November 30, 2022
- Nov 01.2022.Change to Signature Requirement for Title XIX (Medicaid) Home Health Services
- Oct 27.2022.EPH-PR-Prior Authorization Update Criteria for Adakveo J0791 eff 12/01/2022
- Oct 17.2022.EPHMADSNP_Reminder Update Certify NPI via NPPES
- Oct 03.2022.Updated COVID 19 Waiver of CHIP Co Payments_Extension through October 31, 2022
- Oct 03.2022.Updated COVID_19 Telemedicine, Telehealth & Telephone Services (Medical Services)_Extension thru October 31, 2022
- Sept 29.2022.COVID-19 Procedures Codes 0124A 0134A Benefits for Medicaid CHIP
- Sept 22.2022.MCO COVID-19 Vaccine Admin Procedure Codes Age Changed to 12 Years of Age or Older
- Sept 12.2022.Reminder -Benefit Criteria to Change for Vaccine Services Effective 09012022
- Sept 1.2022.Telemedicine and Telehealth Benefit Information
- Sept 1.2022.Updated COVID_19 Telemedicine, Telehealth & Telephone Services (Medical Services)_Extension thru September 30, 2022
- Sept 1.2022.Updated COVID 19 Waiver of CHIP Co Payments_Extension through September 30, 2022
Quarterly Provider Orientations
- Aug.08.2024.STARPLUS Behavioral Health Provider Training
- May.22.2024.BH Provider Orientation Presentation from Apr 24th
- May.20.2024.DSNP TRAINING_INVITE for May 30th
- Apr.24.2024.Invite for Behavioral Health Provider Training
- Apr.15.2024.PCP Provider Quarterly Training Invite
- Apr.10.2024.Electronic Visit Verification Training
- Apr.10.2024.Ancillary Provider Training Presentation for Feb 29th
- Mar.29.2024.OB Specialty Trainging Presentation
- Mar.19.2024.OB Specialty Trainging invite for March 27th
- Feb.19.2024.Ancillary Provider Training invite for Feb 29th
- Oct.26.2023.ABA PROVIDER Presentation
- Oct.20.2023.ABA PROVIDER SPECIALTY TRAINING
- Aug.31.2023.PCP PROVIDER QUARTERLLY ORIENTATION
- Aug.28.2023.PCP PROVIDER QUARTERLLY ORIENTATION INVITE
- Feb.16.2023.PCP PROVIDER QTR ORIENTATION
- May.19.2023.El Paso Health_ OB Specialty Orientation Slides from April
- Feb.16.2023.PCP PROVIDER QTR ORIENTATION
- Oct.21.2022.PROVIDER ANCILLARY TRAINING OCT 27th INVITE
Provider Quality Information
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 or toll free at 1-877-532-3778 You can also send us an email at Complaints_Appeals_Unit@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 or toll free at 1-877-532-3778
Email: Complaints_Appeals_Unit@elpasohealth.com
Fax: 915-298-7872
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 your 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.
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.
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.