Provider Portal

Contracted Provider Forms

PlanLink Access Request Form

Authorization Request Form

For Non-Contracted Providers

If you are interested in becoming a contracted provider with KelseyCare Advantage please submit a Letter of Interest (LOI).

Please include the following:

• Company Overview
• Services Provided (including Specialty Services, if applicable)
• List of Locations
• Geographical Coverage Areas (counties)

Guest Claims Access is now available through our portal for Non-Contracted Providers. Please click the link below to view the status of a claim.

Kelsey CareLink

Guest Claims Tip Sheet

Letters can be submitted to:

Email: affiliateproviders@kelsey-seybold.com

Fax: (713) 442-2775

KelseyCare Advantage
Attn: Network Development
11511 Shadow Creek Parkway
Pearland, Texas 77584

Provider selection is based on numerous factors. You will receive notification regarding the Plan's decision to enter into an agreement generally within six (6) weeks of submission of the LOI.