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
- Access2Care Transportation 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 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 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.
- Comprehensive care program prior authorization request form
- Delivery notification form
- Durable medical equipment prior authorization request form
- Hearing loss screening form
- High risk pregnancy notification form
- Interpreter request form
- Letter of interest questionnaire
- Member acknowledgement statement
- 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
- Private pay agreement
- Provider information change form
- Specialist acting as a primary care provider request form
- STAR and STAR Kids authorized representative form
- W-9 form