Important Update
These EOPs are located within Zelis and are available for your practice to review or abstract, based on practice preference.
If you do not wish to view the EOP within Zelis, you may also view the most recent claim status, including EOPs for dates of service beginning January 2023, on our Provider Portal. The portal can be accessed via the following link: HealthTrio connect - connect Login. If you require help in registering for the provider portal, please follow the link to access training materials and the link to register: HealthTrio Provider Portal - Overview | Rise 360 (articulate.com)
If you have any questions specific to the EOP contents, please contact customer service at (855) 645-8448.
Updated Prior Authorization Forms are posted to the Health Plan website soon. A prior authorization request form should accompany both outpatient and inpatient service requests. To prevent processing delays, ensure that the prior authorization form accompanies your service request, and is complete. Incomplete authorization request forms will not be processed.
Eligibility: Please call customer service for eligibility at (855) 645-8448.
2025 Claim Processing Notice:
- All Address: All addresses on claims submitted -must match the current address on file in our system as address we have on file. Please send address confirmations or questions to providerservices@apex4health.com
- Taxonomy: Memorial Hermann Health Plan requires Taxonomy Codes for billing and rendering providers, when submitting claims. It is critical that the taxonomy code selected as the primary or secondary taxonomy code during a provider’s enrollment with Memorial Hermann Plan is included on all electronic and paper transactions. If a claim is submitted without the pertinent taxonomy information, the claim risks being rejected if taxonomy missing or denied or priced incorrectly if taxonomy information is incorrect.
Taxonomy Code Claim Submissions Required Field
| Memorial Health |
Electronic Claims |
CMS 1500 Form |
UB-04 Form |
| Billing Provider Taxonomy |
2000A, PRV03 |
Box 33b with qualifier ZZ |
Box 81cc with B3 |
| Rendering Provider Taxonomy (required when Rendering Provider information is submitted at the claim and/or service line level) |
2310B, PRV03 |
Box 24j with qualifier ZZ in 24i |
N/A |
| Attending Provider Taxonomy (required on Inpatient Institutional claims) |
2310A, PRV03 |
N/A |
Box 76 with qualifier |
Texas Gold Card law streamlines prior authorizations
Attention Behavioral Health Providers/Optum Network Providers
Attention Participating Provider: Required Annual DSNP Training
Training is offered monthly. Please email Provider Relations at providerservices@apex4health.com for registration and scheduling.
Attention: Timely Filing Reminder
With the start of a new year, we want to remind you to submit claims within the timely filing requirements. We follow the claims submission requirements set forth in the Texas Department of Insurance regulations (95 days) for Commercial plans. We follow CMS guidelines (365 days) for our Medicare Advantage plan.
Provider Manual
Provider Manual
Provider Forms
HMO Waiver of Liability Form
Appeal Request Form
Change of Ownership Form
Request for Executed Agreement Authorization Form
Refund and Overpayment Reporting Form
Provider Change Form
PCP Change Form for Physician Offices
Sample UB Claim Form & Instructions UB-04
Sample Professional Claim Form & Instructions CMS 1500
Medical Management
Prior Authorization Form – Commercial Plans
Prior Authorization Form - MA Part C
Prior Authorization Form - Behavioral Health
2025 Prior Authorization Grid
2025 Prior Authorization Requirements
2025 Prior Authorization Code List
Texas Standard Prior Authorization Form
2022 Prior Authorization Medical Statistics
2025 Clinical Policy
Pharmacy
Pharmacy Benefits and Clinical Services