Manuals and Forms
The Provider Manual is a comprehensive reference guide for our products, value-added programs and services. Our hope is that this will make it easier for you and your staff to collaborate with us in providing excellent service to your Cook Children's Health Plan patients.
- STAR/CHIP/CHIP Perinatal Provider Manual
- STAR Kids Provider Manual
- Pharmacy Provider Manual
- National Vision Administrators (NVA) Provider Manual
Updating Provider Information
Providers must inform the health plan of any changes to their contact information including address, telephone and fax number, group affiliation, etc. It is also important to submit any updates to your panel status such as changing from a closed panel to an open panel as well as any changes to age restrictions. Providers must also ensure that the health plan has current billing information on file to facilitate accurate payment delivery.
Providers may submit demographic changes via our Secure Provider Portal or by completing the Provider Information Change Form located on our Provider Forms webpage. Email the change form to our Network Development team at email@example.com.
Providers must also communicate changes to Texas Medicaid & Healthcare Partnership (TMHP). The Provider Enrollment Management System (PEMS) User Guide provides guidance on submitting demographic updates to TMHP.
In the event of an outage contact Provider Relations at 1-888-243-3312 or CCHPProviderRelations@cookchildrens.org
- Comprehensive care program prior authorization request form
- Delivery notification form
- Durable medical equipment prior authorization request form
- High risk pregnancy notification form
- Interpreter request form
- Letter of interest questionnaire
- Non-emergency ambulance prior authorization form
- Palivizumab (Synagis) prior authorization request form
- Physical, occupational, or speech therapy prior authorization form
- Prior authorization request form
- Private duty nursing (PDN) authorization request packet
- Provider information change form
- Specialist acting as a primary care provider request form
- STAR and STAR Kids authorized representative form
- W-9 form