Providers

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

Sept 1. 2023 - Aug 31, 2024

Sept 1, 2022 – Aug 31, 2023

Quarterly Provider Orientations

Provider Quality Information

Prior Authorizations

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.

Provider Complaints

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.

Provider Appeals

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

Provider Overpayments

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

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.

How to Provide Cultural Sensitive Care

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.

Cultural Competency Training