Medicaid/CHIP Provider Profile

• Member Reassignment Form
• Member Education Form
• SPC Consult Form

Prior Authorizations

• Prior Authorization Information
• Texas Standard Authorization Form
• Community’s Preferred Authorization Form

Allergy Skin Testing and Allergy Therapy Assessment Tool

• Allergy Skin Testing and Allergy Therapy Assessment Tool

Maternity Case Management Program

• ProgenyHealth effective October 25, 2023
• ProgenyHealth® Overview
• ProgenyHealth® FAQ
• ProgenyHealth® Maternity Case Management Program
• Provider Overview Flyer
• Member Pregnancy Flyer – English
• Member Pregnancy Flyer – Spanish
• Member Postpartum Flyer – English
• Member Postpartum Flyer – Spanish
• Pregnancy Referral Program Form

Manuals

• Medicaid/CHIP Provider Manual
• Texas Medicaid Uniform Managed Care Manual
• Texas Medicaid Provider Procedure Manual
• TMHP Manual

MAXIMUS’ THSteps Form

• THSteps Provider Outreach Referral Form Instructions
• THSteps Provider Outreach Referral Form

Links

• Texas Health and Human Services Commission
• Texas Medicaid & Healthcare Partnership
• Texas Medicaid/CHIP Vendor Drug Program
• Annual THSteps Provider Training

Quick Reference Guides

• CHIP Perinatal Quick Reference Guide (Effective 02/15/2023)
• CHIP Quick Reference Guide (Effective 02/15/2023)
• HEDIS Quick Reference Guide
• THSteps Quick Reference Guide
• STAR Quick Reference Guide (Effective 02/15/2023)
• THSteps Medical Checkup Billing Procedure Codes (Revised 02/01/2023)
• THSteps Medical Checkup Periodicity Schedule
• Community’s THSteps Resource Guide
• Member Safety Plan

Synagis Program

• Synagis: Texas Medicaid STAR/CHIP
• Synagis Prior Authorization Request Form
• Synagis: Texas Vendor Drug Program

Clinical Practice Guidelines

• Clinical and Preventive
• ICD-10 Preparation

Provider Complaints

• How to Submit a Complaint as a Medicaid Provider

Provider Appeals

• Provider Appeal Form

Provider Payment Dispute

• Provider Payment Dispute Form

Member Requests

• Member Request to Change Primary Care Provider

Provider Manuals

• Provider Manual
• Provider Nursing Facility Manual

Provider Complaints

• How to submit a complaint for STAR+PLUS

Provider Medical Appeal 

• Provider Medical Appeal Form

Attendant Compensation Rate Enhancement Program (ACEP)

• ACEP Information
• ACEP Form

Provider Claims Payment Appeal 

• Provider Claims Payment Appeal Information
• Provider Claims Payment Appeal Form

Provider Manuals

• Provider Manual
• Provider Orientation
• Model of Care for Out of Network Providers
• Care Transitions & Continuity of Care Training for Providers, Office Staff, and FDRs
• Cultural Competency

Prior Authorizations

• Prior Authorization Information
• Texas Standard Authorization Form
• Community’s Preferred Authorization Form

Quick Reference Guides

• Quick Reference Guide
• Waiver of Liability

Allergy Skin Testing and Allergy Therapy Assessment Tool

• Allergy Skin Testing and Allergy Therapy Assessment Tool

Clinical Practice Guidelines

• Clinical and Preventive

Provider Appeals

• Provider Appeal Form

Provider Payment Dispute

• Provider Payment Dispute Form

Member Requests

• Member Request to Change Primary Care Provider

• Marketplace Provider Manual
• Quick Reference Guide (Effective 01/01/23)
• HEDIS Quick Reference Guide
• Top 10 Suggestions for Documentation
• Chasing the Chart
• ICD-9 to ICD-10 Crosswalk General Equivalence Mappings (GEMS)
• Clinical Practice Guidelines Clinical and Preventive

• Allergy Skin Testing and Allergy Therapy Assessment Tool

• Provider Appeal Form

• Provider Payment Dispute Form

• Prior Authorization Information
• Texas Standard Authorization Form
• Community’s Preferred Authorization Form

• ProgenyHealth effective October 25, 2023
• ProgenyHealth® Overview
• ProgenyHealth® FAQ
• ProgenyHealth® Maternity Case Management Program
• Provider Overview Flyer
• Member Pregnancy Flyer – English
• Member Pregnancy Flyer – Spanish
• Member Postpartum Flyer – English
• Member Postpartum Flyer – Spanish
• Pregnancy Referral Program Form

• Member Request to Change Primary Care Provider

• Member Appeal form – English
• Member Appeal form – Spanish