CareLink Provider Information

The information found on this page is for CareLink provider use only. Any other use is strictly prohibited.

Provider Manual

Provider Contracting

CareLink strives to assure that services received by the members are provided by a qualified and licensed health care professional. Effective September 1, 2009 all CareLink providers must be appropriately credential prior to providing services to CareLink members.

Process

All CareLink providers must complete and submit the Texas Common Credentialing Application to Yolanda Sandoval, Senior Provider Relations Representative, who in turn will submit the application to the Professional Staff Services Department. Professional Staff Services will process the credentialing form consistent with NCQA credentialing guidelines.

  1. Upon completion of all verification and processing, Professional Staff Services shall submit the application and the verified documents to the CareLink Credentials Committee.
  2. The CareLink Credentials Committee shall review and make a final determination regarding the application.
  3. The CareLink Executive Director may authorize Interim Privileges not to exceed 90 days in conjunction without of network agreements.
  4. Once the provider has been credentialed a CareLink provider number will be provided to physician.

For additional information:

Please email Yolanda.Sandoval@uhs-sa.com.
All completed forms can be submitted via fax to 210-358-3863.

Clinical and Healthcare Resources

Member Services Representatives

210-358-3350

CareLink Member Eligibility Verification

48 hour turnaround

Provider Hotline for same day appointments (only)

210-358-3719
210358-3224

Authorization Nurse

Fax: 210-702-4203

Claims Inquires

210-358-3376
Fax: 210-358-5866

CareLink Administration

210-358-3180
Fax: 210-358-3863

Access Plus

210-358-3158

Provider Relations

210-358-9587
Fax: 210-358-3863

Member Resolutions

210-358-3430
Fax: 210-358-3171

Pre-Authorization Submission

CareLink helps to pay for the cost of medical care received within University Health System and with those agencies under the contract system. Certain services require prior-authorization. Please provide 72 business hours to provide a pre-determined authorization.

  • Please note that CareLink does not require pre-authorization for Urgent or Emergent Services.

Precertification/Referral Authorization

Services requiring prior-authorization are:Any facility services not performed at University 

  • Hospital
  • Any specialty care outside UT Medicine San
    Antonio/UHS
  • Any office-based procedure service where the
    Medicare approved fee is $250.00 or more
  • BiPAP
  • Cardiac Catheterization: outpatient, non-emergent
  • Cardiac rehabilitation
  • Chemotherapy: outpatient/inpatient
  • CPAP
  • Cystoscopy
  • Dental Extractions
  • Dental/Oral Maxilo Surgery
  • Durable Medical Goods and Equipment
  • Elective 23 hour observation
  • Elective admission
  • Elective Outpatient surgery/day surgery
  • Endoscopics: outpatient
  • HLA Typing
  • Home Health
  • Hydrotherapy: outpatient
  • Implantable defibrillator
  • Rehabilitation: inpatient/outpatient
  • Drug/alcohol addiction rehabilitation
  • Multi channel urodynamic study
  • Non-subsidized/non-formulary medication
  • Occupational therapy
  • Oxygen at home
  • Pain clinic
  • PET Scans
  • Physical therapy
  • Plastic surgery
  • Prosthetics/orthotics
  • Radiation therapy/IMRT
  • Radiology: open side MRI
  • MRA
  • Sleep study
  • Speech therapy
  • Stem Cell Transplant
  • Surgery with same day admission
  • Therapeutic abortion
  • TMJ
  • Tubal: inpatient/outpatient
  • Video urodynamic study
  • Vasectomy


Claims

Claims are to be submitted in accordance with the current American Medical Association (AMA) and Centers for Medicare and Medicaid Services coding and billing guidelines. CareLink utilizes nationally accepted billing practices and guidelines in adjudicating claims. Unless the claims are disputed, CareLink will make payment on covered services rendered to qualified CareLink Members within contracted period on each of the providers clean, complete, accurate, and timely submitted claims.

For questions regarding claims or to check claim status, please call: 210-358-3376

Forms

Prescription Newsletter

2013
Spring | Fall

2014
Summer | Fall

Medication Formulary Updates (.pdf adobe file icon)

2015
Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct

2014
Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec

2013
Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec

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