El Paso First Healthplans, inc.
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Providers - Forms
Web Portal Forms
  • Web Portal Registration Form
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  • Web Portal User Agreement
    •
    Health Services Forms
  • Case Management Referral
  • Fax Cover for Pregnant Woman Visit
  • Notification of Pregnancy
  • Pre-Authorization Flyer
  • Pre-Certification Fax Form-Inpatient
  • Pre-Certification Fax Form-Outpatient
  • Pre-Certification Fax Form-Behavioral Health
  • Pre-Certification Fax Form-Out of Area
  • Pre-Certification Checklist
    • Complaints and Appeals Forms
  • Filing for Fair Hearing
  • Request for a Review by an Independent Review Organization
    • Members Services Forms
  • Authorization to Disclose information to PCP
  • Medicaid Eligibility Form
  • Private Pay Form
  • Specialist as a PCP Request Form
  • Outreach/Member Advocate Referral Form
    • Claims How to Fill Out
  • Corrected Claim
  • How to fill out a 1500 Claim form
    • Credentialing Packet Forms
  • Demographic Form
  • W9 Form - Request for Taxpayer Identification Number and Certification
  • Credentialing Application Checklist
  • Texas Standardized Credentialing Application
    • Misc. Forms
  • Electronic Funds Transfer Agreement
  • EDI Packet
  • Healthx Fax System
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