Request access

Third-party administrator representatives must ask the managed care carrier to email an authorization letter to PromptPay@tdi.texas.gov. The letter must be on the manage care carrier's letterhead and include:

Your name, title, email, and phone number.
A managed care carrier authorized representative's name, title, and signature.

After we receive that letter and verify the authorization, the person who needs access will get an email with a temporary password.

Licensed HMO or insurer representatives must fill out this form. After we receive the form, the person requesting access will get an email with a temporary password.

First name

Last name

Company name

Phone

Extension (optional)

NAIC number

Are you a third-party administrator (TPA)?

Yes No

All fields are required unless stated as optional.

Request access

Don't fill out this request access form if you work for a third-party administrator.