Provider Forms

PCHP Forms

Coordination of Care/Treatment Summary Form

Fax Cover

Newborn Notification Form

Portal User Guide

Prospective Provider Form: Join our Network!

Provider Action Form: Update your information with PCHP

Provider Claim Appeal Request Process & Form

Provider Claim Resubmission Request Process & Form

Refund Information Form

STAR Medicaid Member Appeal and Grievance Process

Texas Medicaid & Healthcare Partnership

Prior Authorization Forms & Resources