Provider Forms & Resources

Provider Forms & Resources

Below you can find our most frequently used provider forms and resources for CHRISTUS Health Plan insurance. For ERA enrollment, please call with questions or to check enrollment status. If you are hard of hearing, call 1-800-735-2989 in Texas or 1-800-659-8331 in New Mexico.

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

2018 Provider Letter - Change to Medicare ID Card (PDF)
2018 QMB Provider Notification Letter (PDF)
2018 Notice to Physicians and Providers (PDF)

Provider Portal Resources

Provider Portal User Guide