Manuals and forms
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Manuals and forms
Manuals and guides
Downloadable forms
- Behavioral Health Prior Auth Form
- Dell Children’s Health Plan Prior Authorization Form
- Disease Management Referral Form
- Provider payment disputes—file disputes through the provider portal.
- Specialist as Primary Care Provider Request Form
- Texas Health Steps Provider Outreach Referral Form
- Texas Standard Prior Authorization Request Form for Health Care Services
- Texas Standard Prior Authorization Request Form for Prescription Drug Benefits
Behavioral health
- Behavioral Health Initial Review Form for Inpatient, Residential Treatment Center, Partial Hospital Program and Intensive Outpatient Program
- Behavioral Health Concurrent Review Form for Inpatient, Residential Treatment Center, Partial Hospital Program and Intensive Outpatient Program
- TRR UM Guidelines – Adult Mental Health Services
- TRR UM Guidelines – Child Adolescent Services
- Claims for Telephone BH Services
- Behavioral Health Discharge Assistance
- All other Behavioral Health Assistance
- Behavioral Health Provider Search
Provider Advisory Group
Dell Children’s Health Plan invites you to participate in our Provider Advisory Group. If you would like more information on how to get involved and what participating in this group entails, please contact us at Provider Services at 512-324-3125, option 4 or by email at shpproviderservices@seton.org.
Updating provider information with Dell Children's Health Plan
- If you are an already contracted group but need to add a new provider, you can easily submit the Add a Provider to an Existing Group Contract form to our Provider Relations inbox at shpproviderservices@seton.org.
- If you need to make any changes to a provider’s address, phone number, group affiliation or other updates, please request for our “Additional Changes Roster” spreadsheet by emailing our Provider Relations inbox at shpproviderservices@seton.org.
