Forms

Below you can find our most frequently used provider forms and resources for CHRISTUS Health Plan and US Family Health Plan. For ERA enrollment, please call with questions or to check enrollment status.

If you are hard of hearing, call 711.

Health Insurance Exchange: 1-844-282-3025
Medicare Advantage: 1-844-282-3026
US Family Health Plan: 1-800-678-7347

Forms

• Prospective Provider Form (PDF)
• ERA Form (PDF)
• Texas Standard Prior Authorization Form (PDF)
• Member Acknowledgement Form (PDF)
• Private Pay Agreement Form (PDF)
• Consent for Disclosure of Confidential Information Form (PDF)
• Training Attestation Form – Gen. Compliance and FWA Form (PDF)

Medicare Advantage Resources

• Provider Letter - Change to Medicare ID Card (PDF)
• QMB Provider Notification Letter (PDF)
• Notice to Physicians and Providers (PDF)

Provider Portal Resources

• Provider Portal User Guide (PDF)