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Provider Enrollment on the Portal Instructions
Important: You must be enrolled in Traditional Medicaid before enrolling in CSHCN or Texas Health Steps. Select "Add to an Existing Enrollment," then click "Apply Filters" if you would like instructions for adding CSHCN or Texas Health Steps to your existing enrollment.
Page Filters
These pages will guide you through each stage of the enrollment process using PEP. To customize this page's content, use the filters below and click the Apply Filters button.

Application Type:

Program(s):

Enrolling As:

Disclosure of Relationship Form

Instructions for Completing the Disclosure of Relationship Form.

Note: This page does not apply to Ordering and Referring Providers.

Note: This page does not apply to Performing Providers.

  • Please disclose any of the following familial relationships between principals and the provider.

    • Section: Relationship

  • If you have a familial relationship with a principal, click Add Relationship and complete the required fields.
  • Select the appropriate Provider/Principal for “Provider/Principal 1.”
  • Select the appropriate relationship for “Has a Relationship as.”
  • Select the appropriate Provider/Principal for “To Provider/Principal 2.”
  • Click Done.
  • If applicable, click Add Another Relationship.
  • If there are no known relationships, check the box to acknowledge that there are no known relationships.
 
Contents
Go directly to a specific page's instructions by using the links below.