Document Library

New Offerings – Information and Opt-Ins – Click the Link Below:


  • New For 2023
    • Tower Extrusions – 01/2023
    • Envolve Vision – 01/2023
    • Provider Partners Health Plan – 01/2023
    • MultiPlan Med Adv Wrap – 02/2023
    • Aetna Contract Expanded to certain South Texas counties – 04/2023
    • American Health Plan of TX (AHP of TX) – 04/2023
    • PROCURA/Optum – 04/2023
  • Networks Closed
    • Cigna Healthspring Star+Plus – All patients transitioning to Molina
    • Stone Mountain
    • Bright Health
    • HealthScope DART
    • Coventry
    • TowerExtrusions
    • Friday
    • HealthEZ

New Member Applications

 

PAPER APPLICATIONS ARE BEING PHASED OUT AT THE END OF JAN 2024!
PLEASE USE THE HUB FOR ALL APPLICATION GOING FORWARD. 

 


Physicians

2022-2023 Tiopa Physician Application

2022-2023 Tiopa BH Physician Application

Non-Physician

2022-2023 Tiopa Non-Physician Application

2022-2023 Tiopa Non-Physician BH Application

All Providers

Extra Services Online Form

Before completing the extra service form you will need, your CP 575 Letter from the IRS and a Bank Letter or voided check, a Certificate of Formation from the Secretary of State, and a Driver’s License for the provider and all owners.