Affiliate Providers

Kelsey CareLink Login

Kelsey CareLink is a secure online portal offering referring physicians access to their patients' up-to-date electronic health records to track appointments, lab results, medications, verify eligibility, check claims status and more.

If you encounter errors when trying to review claim status from this screen, please call 713-442-4257.

• 2025 Utilization Management Authorization Request Form
• Utilization Management - Memorandum for PA List Additions Q2 2025
• Utilization Management - Transition of Care/Continuity of Care Form
• Utilization Management - KelseyCare Advantage Prior Authorization list effective 4/13/2025
• Claim Submission Information
• Provider Reconsideration & Dispute Request Form – KelseyCare Advantage
• Provider Reconsideration & Dispute Request Form – Kelsey-Seybold Clinic

Claims Submission Information

All claims for authorized, covered services provided to eligible, Kelsey-Seybold assigned HMO, POS and EPO members must be submitted on a CMS 1500 form, a UB 04, or in an electronic format, as applicable. Claims submitted with ‘Unlisted Procedure Codes’ must include documentation supporting the use of that code for payment consideration. If necessary to determine if the claim is payable, Kelsey-Seybold may within thirty (30) days of receipt of a clean claim, request additional information from the treating provider.
For update to date claim filing directions please visit National Uniform Claim Committee - 1500 Instructions (nucc.org)

CLAIMS / DISPUTES / APPEALS / REFUNDS

Become An Affiliate Provider

If you are interested in becoming a contracted provider with Kelsey-Seybold Clinic please submit a Letter of Interest (LOI) by completing this form.

Or submit an LOI and include the following information:

• A company overview
• Services provided
• Your location(s)
• Geographical coverage areas
• Specialty services
• Medical staff roster, if applicable.

Submit LOI's to:

Kelsey-Seybold Clinic / PGT Provider Manual (update August 2025)