HOME ABOUT SERVICES CAREERS CONTACT BLOG LOGINS/FORMS Scroll down to access logins & download forms. Provider Portal Login to your Provider Portal to view claim status, benefits, eligibility & more. LOG IN Designation of Authorized Representative General Chemotherapy Pre-Authorization Form General Infusion Therapy Pre-Authorization Form General Pre-Authorization Form General Psychiatric UR QA Review Form General Radiation Therapy Information Form General Pre-Determination Request Form Construction Protective Services - Pre-Authorization Form El Pollo Loco - Pre-Authorization Form Galveston County - Indigent Healthcare Pre-Authorization Form Galveston County Jail - Pre-Authorization Form MCHD - Pre-Authorization Form Steven's Transport - Pre-Authorization Form Boon-Chapman 9401 Amberglen Blvd. Building I, Suite 100 Austin,TX 78729 www.boonchapman.com MEMBERS EMPLOYERS PROVIDERS 800-252-9653 (Fax) 512-459-1592 sales@boonchapman.com customerservice@boonchapman.com recruitment@boonchapman.com Click Here to View Our Privacy Policy

HOME ABOUT SERVICES CAREERS CONTACT BLOG LOGINS/FORMS With 60 years of experience administering self-funded health plans, our professionals are experts at designing plans that help employers minimize spend and deliver superior care. Services CLAIMS ADMINISTRATION CUSTOMER SERVICE & CALL CENTER HOSPITAL BILL AUDITING PREMIUMS & ELIGIBILITY REGULATORY COMPLIANCE COBRA, HIPAA & FLEX DIRECT CONTRACTING PPO NETWORKS COMMUNITY PLANS MEMBER ADVOCACY Technology CLAIMS SYSTEM CODE EDITING ONLINE ENROLLMENT MILLIMAN ADVANCED RISK ADJUSTERS COMBINED BILLING DEERWALK ANALYTICS SELF-SERVICE PORTALS TRUVEN HEALTH ANALYTICS Reporting PLAN REPORTING PLAN ANALYTICS PREDICTIVE MODELING NORMATIVE DATA CARE GAP ALERTS Additional Services Population Health Management LEARN MORE BPO Service LEARN MORE Get In Touch Boon-Chapman 9401 Amberglen Blvd. Building I, Suite 100 Austin,TX 78729 www.boonchapman.com MEMBERS EMPLOYERS PROVIDERS 800-252-9653 (Fax) 512-459-1592 sales@boonchapman.com customerservice@boonchapman.com recruitment@boonchapman.com Click Here to View Our Privacy Policy