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ALERT! We now encourage our patients to save their spot in line before coming into the clinic.

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ATENCIÓN MIEMBROS: ¡La política de flexibilidad para apelaciones finaliza pronto! | Haz clic aquí para saber más.

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Provider Forms and Manuals

Below you will find useful forms for you and your practice. If you wish to open the following forms, you must have Adobe Acrobat Reader installed on your computer. To download a form, right click on one of the links below and select "Save Target As."

To download a free copy of Adobe Acrobat Reader, click here.

Reimbursement Information for CHIP Co-Payment Waiver


  • Medical Inpatient Admissions and Discharge Notifications - 832-825-8462 or Toll-Free 844-663-7071
  • Medical Services Fax Line - 832-825-8760 or Toll-Free 1-844-473-6860
  • Behavioral Health Services Fax Line - 832-825-8767 or Toll-Free 1-844-291-7505
  • LTSS and Private Duty Nursing Fax Line - 346-232-4757 or Toll-Free 1-844-248-1567
  • Post Hospital Discharge Authorizations Fax Line - Toll-Free 866-839-9879

Case Management

Physician Requests

Provider Manuals

Other Forms