Physician Self-Service Center
A 100% web-based application that enables clinic staff and physicians to verify patient eligibility, claims status and referral status for the Seton employee plans (SHP1, SHP2, and EPN); Seton Health Plan CHIP; City MAP (CBRACKFQ Group); SETONCare Plus and Charity. To ensure secure, safe and confidential transactions, you must become a registered user.You will need the free Acrobat Reader, a browser plug- in to view or print some of the documents below.
Reference Center
Seton Employee Health Plan Benefit Comparison Grid 81 KB pdf
Provider Inservices
Provider In-service Plan Year 2010 472 KB pdf
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Provider Directories
Texas True Choice Texas Physicians 2,645 KB pdf Texas True Choice Texas Facilities and Ancillary Providers 446 KB pdf CHIP 561 KB pdf Seton Promise Provider Directory 671 KB pdf
For EPN and Expanded EPN SPHN providers please utilize the online "Provider Search" above.
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Referral and Authorization Procedures
Referral/Precertification Form
Seton Employees, Seton Promise, SETONCare Plus, MAP, CCHC and Charity 197 KB pdf Referral/Precertification Form
Seton Health Plan CHIP 991 KB pdf Prior Authorization List
updated as of 05/25/201068 KB xls
Seton Employees, Seton Promise, SETONCare Plus, MAP, CCHC and Charity 197 KB pdf Referral/Precertification Form
Seton Health Plan CHIP 991 KB pdf Prior Authorization List
updated as of 05/25/201068 KB xls
Listing of procedures/services that require prior authorization
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Prescription Drug Benefit Guides
Listing of self administered oral and injectable prescription medications that require authorization
Seton Employee Plan: Self administered Medications Requiring Authorization 35 KB pdf Seton Employee Plan: Prescription Medication Prior Authorization Process 17 KB pdf
Authorization form for self administered oral prescription medications.
Seton Employee Plan: Oral Medication Authorization Form 22 KB pdf
Authorization form for self administered injectable medications (excludes insulin)
Seton Employee Plan: Injectable Medication Authorization Form 47 KB pdf
Listing of formulary medications
Seton Employee Plan: Formulary 76 KB pdf SETON/Care Plus: Formulary/ By Alpha Order/Drug Class 287 KB pdf
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CHIP Benefit Documents
CHIP Evidence of Coverage and Scope of Benefits 105 KB pdf CHIP Member Enrollment Issue 35 KB pdf At or Below 100% FPL 133 KB pdf 101% to 150% of FPL 135 KB pdf 151% to 185% of FPL 135 KB pdf 186% to 200% of FPL 133 KB pdf Native American 133 KB pdf
Copayment Schedule 9 KB pdf CHIP Provider Manual 448 KB pdf
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Copayment Schedule 9 KB pdf CHIP Provider Manual 448 KB pdf
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