CareLink Provider Information
The information found on this page is for CareLink provider use only. Any other use is strictly prohibited.
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.
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.
- Upon completion of all verification and processing, Professional Staff Services shall submit the application and the verified documents to the CareLink Credentials Committee.
- The CareLink Credentials Committee shall review and make a final determination regarding the application.
- The CareLink Executive Director may authorize Interim Privileges not to exceed 90 days in conjunction without of network agreements.
- 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 210-358-3082.
Clinical and Healthcare Resources
Member Services Representatives
CareLink Member Eligibility Verification
|48 hour turnaround
CareLink helps to pay for the cost of medical care received within University Health 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.
Services requiring pre-authorization are any facilities services not performed at University Health, or any services where the professional component is greater than $250 per the Medicare fee schedule.
- Any specialty care outside UT Health San
- Any office-based procedure service where the
Medicare approved fee is $250.00 or more
- Cardiac Catheterization: outpatient, non-emergent
- Cardiac rehabilitation
- Chemotherapy: outpatient/inpatient
- Dental Extractions
- Dental/Oral Maxilo Surgery
- Durable Medical Goods and Equipment
- Elective 23 hour observation
- Elective admission
- Elective Outpatient surgery/day surgery
- Endoscopics: outpatient
- Home Health
- Hydrotherapy: outpatient
- 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
- Radiation therapy/IMRT
- Radiology: open side MRI
- Sleep study
- Speech therapy
- Stem Cell Transplant
- Surgery with same day admission
- Therapeutic abortion
- Tubal: inpatient/outpatient
- Video urodynamic study
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 to CareLink Network Providers for services rendered to qualified CareLink members within the contracted period on each of the provider’s clean, complete, accurate and timely submitted claims.
For questions regarding claims or to check claim status, please call: 210-358-3376
Medication Formulary Updates (.pdf )
Pdf files require Adobe Acrobat Reader to view. You can download Acrobat Reader for free from Adobe's website. Please follow the link below to download the program.