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C25.2649885,12.5036425 25.2649885,12.5358822 25.2325975,12.5681219 Z" id="Shape"></path></g></g></g></g></svg> </span> </a> </li> <li class="breadcrumb-item"> <a href="/providers/"> <span>For Providers</span> </a> </li> <li class="breadcrumb-item"> <a href="/providers/provider-manual-and-forms/"> <span>Manuals and Forms</span> </a> </li> </ol> </div> <div class="interior-page"> <div class="top-content-wrapper"> <div class="content-wrapper"> <div class="document-header"> <h1 data-epi-type="title">Manuals and Forms</h1> </div> <div class="content-area" data-epi-type="content"> <div class="right-content"> <div class="score-accordion section-menu-wrapper"> <div class="score-accordion-panel"> <div class="panel-heading"> <div class="panel-title"> <button type="button" class="accordion-button" data-target="#sectionMenu" aria-expanded="false" aria-controls="accordion1"> In This Section </button> </div> </div><div id="sectionMenu" class="panel-collapse collapse"> <div class="panel-body"> <div class="bg-lightgrey"> <ul class="main"> <li class="section-menu-item "> <a href="/providers/" aria-label="For Providers" class="GTMMENU" target="_self"> For Providers </a> </li> </ul> <ul class="level-1"> <li class="section-menu-item "> <a href="/providers/behavioral-health-services/" aria-label="Behavioral Health Services" class="GTMMENU" target="_self"> Behavioral Health Services </a> </li> <li class="section-menu-item "> <a href="/providers/complaints-and-appeals/" aria-label="Complaints and Appeals" class="GTMMENU" target="_self"> Complaints and Appeals </a> </li> <li class="section-menu-item "> <a href="/providers/electronic-submission-services/" aria-label="Electronic Submission Services" class="GTMMENU" target="_self"> Electronic Submission Services </a> </li> <li class="section-menu-item "> <a href="/providers/electronic-visit-verification/" aria-label="Electronic Visit Verification" class="GTMMENU" target="_self"> Electronic Visit Verification </a> </li> <li class="section-menu-item "> <a href="https://www.cookchildrens.org/healthcare-professionals/professional-education/grand-rounds-video-library/" aria-label="Grand Rounds Video Library" class="GTMMENU" target="_self"> Grand Rounds Video Library </a> </li> <li class="section-menu-item "> <a href="/providers/provider-hhsc-news/" aria-label="HHSC News" class="GTMMENU" target="_self"> HHSC News </a> </li> <li class="section-menu-item "> <a href="/providers/joining-the-network/" aria-label="Joining the Network" class="GTMMENU" target="_self"> Joining the Network </a> </li> <li class="section-menu-item "> <a href="/providers/long-term-services-and-support/" aria-label="Long Term Services and Supports" class="GTMMENU" target="_self"> Long Term Services and Supports </a> </li> <li class="section-menu-item active"> <a href="/providers/provider-manual-and-forms/" aria-label="Manuals and Forms" class="GTMMENU" target="_self"> Manuals and Forms </a> </li> <li class="section-menu-item "> <a href="/providers/pharmacy-information/" aria-label="Pharmacy Information" class="GTMMENU" target="_self"> Pharmacy Information </a> </li> <li class="section-menu-item "> <a href="/providers/prior-authorization-search/" aria-label="Prior Authorization" class="GTMMENU" target="_self"> Prior Authorization </a> </li> <li class="section-menu-item "> <a href="/providers/Private-Duty-Nursing/" aria-label="Private Duty Nursing" class="GTMMENU" target="_self"> Private Duty Nursing </a> </li> <li class="section-menu-item "> <a href="/providers/provider-news/" aria-label="Provider News" class="GTMMENU" target="_self"> Provider News </a> </li> <li class="section-menu-item "> <a href="/providers/provider-relations/" aria-label="Provider Relations" class="GTMMENU" target="_self"> Provider Relations </a> </li> <li class="section-menu-item "> <a href="/providers/quality-improvement/" aria-label="Quality Improvement" class="GTMMENU" target="_self"> Quality Improvement </a> </li> <li class="section-menu-item "> <a href="/providers/resources/" aria-label="Resources" class="GTMMENU" target="_self"> Resources </a> </li> <li class="section-menu-item "> <a href="https://epiccarelink.cookchp.org/LinkHealthPlan/common/epic_login.asp" aria-label="Secure Provider Portal" class="GTMMENU" target="_self"> Secure Provider Portal </a> </li> <li class="section-menu-item "> <a href="/providers/texas-health-steps/" aria-label="Texas Health Steps" class="GTMMENU" target="_self"> Texas Health Steps </a> </li> <li class="section-menu-item "> <a href="/providers/therapy-information/" aria-label="Therapy Information" class="GTMMENU" target="_self"> Therapy Information </a> </li> </ul> </div> </div> </div> </div> </div> </div> <div class="top-content"> <div class="rte-content"> <div class="rich-text"><p>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.</p> <ul> <li><a title="STAR/CHIP/CHIP Perinatal" href="/siteassets/documents/pdfs/provider-manual/star-chip-chip-perinatal-provider-manual-042524.pdf" target="_blank" rel="noopener">STAR/CHIP/CHIP Perinatal Provider Manual</a></li> <li><a title="STAR Kids Provider Manual" href="/siteassets/documents/pdfs/provider-manual/star-kids-provider-manual-042524.pdf" target="_blank" rel="noopener">STAR Kids Provider Manual</a></li> <li><a href="https://pharmacies.navitus.com/" target="_blank" rel="noopener">Pharmacy Provider Manual</a></li> <li><a href="/siteassets/documents/pdfs/provider-manual/nva-provider-manual.pdf" target="_blank" rel="noopener">National Vision Administrators (NVA) Provider Manual</a></li> <li><a title="Access2Care Transportation Provider Manual" href="/siteassets/documents/pdfs/provider-manual/access2care-transportation-provider-manual.pdf" target="_blank" rel="noopener">Access2Care Transportation Provider Manual</a></li> </ul> <h2>Updating Provider Information</h2> <p>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.</p> <p>Providers may submit demographic changes via our <a href="https://epiccarelink.cookchp.org/LinkHealthPlan/common/epic_login.asp">Secure Provider Portal</a> by selecting the Customer Service icon from the homepage and selecting the topic Provider Demographic Changes. Providers pending access approval to the Secure Provider Portal can complete the Provider Information Change Form located below under Provider Forms. Email the completed Provider Information Change form to our Network Development team at <a href="mailto:cchpnetworkdevelopment@cookchildrens.org">cchpnetworkdevelopment@cookchildrens.org</a>.</p> <p>Providers must also communicate changes to Texas Medicaid & Healthcare Partnership (TMHP). The <a href="https://www.tmhp.com/topics/provider-enrollment/pems/start-application" target="_blank" rel="noopener">Provider Enrollment Management System (PEMS) User Guide </a>provides guidance on submitting demographic updates to TMHP.</p> <p><strong><a style="text-decoration: none;" title="CCHPProviderRelations@cookchildrens.org" href="mailto:CCHPProviderRelations@cookchildrens.org">CCHPProviderRelations@cookchildrens.org</a></strong></p> <p> </p> <h2>Provider Forms</h2></div> </div> <div class="score-accordion " id="80589623-09c9-402e-9b45-cb0c08a0f083"> <div class="score-accordion-panel "> <div class="panel-heading"> <h3 id="7bd599d8-0e3e-41dd-a139-6fbb11683489-title" class="panel-title"> <button type="button" class="accordion-button GTMBUTTON" data-target="#7bd599d8-0e3e-41dd-a139-6fbb11683489-panel" aria-expanded="false" aria-controls="7bd599d8-0e3e-41dd-a139-6fbb11683489-panel"> Provider Forms </button> </h3> </div> <div id="7bd599d8-0e3e-41dd-a139-6fbb11683489-panel" class="panel-collapse collapse "> <div class="panel-body"> <div class="rich-text"> <h4> </h4> <div class="rich-text"><ul> <li><a title="Comprehensive care program prior authorization request form" href="/siteassets/documents/pdfs/provider-manual/comprehensive-care-program-prior-authorization-request-form-2024.pdf">Comprehensive care program prior authorization request form</a></li> <li><a title="Delivery Notification Form" href="/siteassets/documents/pdfs/provider-manual/delivery-notification-form-2024.pdf" target="_blank" rel="noopener">Delivery notification form</a></li> <li><a title="Durable medical equipment prior authorization request form" href="/siteassets/documents/pdfs/provider-manual/durable-medical-equipment-prior-auth-request-form-2024.pdf" target="_blank" rel="noopener">Durable medical equipment prior authorization request form</a></li> <li><a title="Hearing Loss Screening Form" href="/siteassets/documents/pdfs/provider-manual/hearing-loss-screening-form-11192024.pdf" target="_blank" rel="noopener">Hearing loss screening form</a></li> <li><a title="High Risk Pregnancy Notification Form" href="/siteassets/documents/pdfs/provider-manual/high-risk-pregnancy-notification-form-2024.pdf" target="_blank" rel="noopener">High risk pregnancy notification form</a></li> <li><a title="interpreter request form" href="/siteassets/documents/pdfs/provider-manual/interpretation-request-form-2024.pdf" target="_blank" rel="noopener">Interpreter request form</a></li> <li><a title="Letter of Interest Questionnaire" href="/siteassets/documents/pdfs/provider-manual/letter-of-interest-questionnaire-form-2024.pdf" target="_blank" rel="noopener">Letter of interest questionnaire</a></li> <li><a title="Member Acknowledgement Statement" href="/siteassets/documents/pdfs/provider-manual/member-acknowledgment-statement-2024.pdf" target="_blank" rel="noopener">Member acknowledgement statement</a></li> <li><a title="Non-Emergency Ambulance Prior Authorization Form" 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