STAR/CHIP Provider Forms

• Member Reassignment Form
• Member Education Form
• Specialist Consultant Form

Prior Authorizations

• Provider Authorization Information (including PA Catalog)
• 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

Patient Decision Aids (PDAs)

PDAs are tools that help patients and providers talk together about care options. These PDAs can be used to discuss breast cancer screening options.

• Should I Get a Mammogram? (ages 40-49) English version,  Español/Spanish version
• How Often Should I Get a Mammogram? (ages 50-74) English version, Español/Spanish version
• Should I Get a Mammogram? (ages 75+) English version,  Español/Spanish version

Manuals

• Medicaid/CHIP Provider Manual
• Texas Medicaid Uniform Managed Care Manual
• Texas Medicaid Provider Procedures 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
• CHIP Quick Reference Guide
• STAR Quick Reference Guide 
• HEDIS Quick Reference Guide
• THSteps Quick Reference Guide
• THSteps Medical Checkup Billing Procedure Codes (Revised 02/01/2023)
• THSteps Medical Checkup Periodicity Schedule
• Community’s THSteps Resource Guide
• Member Safety Plan
• Patient decision aids (PDAs) | Washington State Health Care Authority

Synagis Program

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

Clinical Practice Guidelines

• Clinical and Preventive

Provider Complaints

• How to Submit a Complaint as a Medicaid Provider

Provider Medical Appeals

• Provider Medical Appeal Form

Provider Claims Payment Appeal

• Provider Claims Payment Appeal Form

Member Requests

• Member Request to Change Primary Care Provider

STAR+PLUS Provider Forms

• Specialist Consultant Form

Provider Manuals

• Provider Manual
• Provider Nursing Facility Manual

Quick Reference Guides

• Quick Reference Guide

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

Medicare Provider Forms

• Specialist Consultant Form

Provider Manuals

• Medicare 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

• Provider Authorization Information (including PA Catalog)
• 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 Medical Appeals

• Provider Medical Appeal Form

Provider Claims Payment Appeal

• Provider Claims Payment Appeal Form

Member Requests

• Member Request to Change Primary Care Provider

Health Insurance Marketplace Provider Forms

• Specialist Consultant Form

Provider Manuals

• Marketplace Provider Manual
• Quick Reference Guide 
• HEDIS Quick Reference Guide
• Top 10 Suggestions for Documentation
• Chasing the Chart
• Clinical Practice Guidelines Clinical and Preventive

Allergy Skin Testing and Allergy Therapy Assessment Tool

• Allergy Skin Testing and Allergy Therapy Assessment Tool

Provider Medical Appeals

• Provider Medical Appeal Form

Provider Claims Payment Appeal

• Provider Claims Payment Appeal Form

Prior Authorizations

• Provider Authorization Information (including PA Catalog)
• Texas Standard Authorization Form
• Community’s Preferred Authorization Form

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

Patient Decision Aids (PDAs)

PDAs are tools that help patients and providers talk together about care options. These PDAs can be used to discuss breast cancer screening options.

• Should I Get a Mammogram? (ages 40-49) English version,  Español/Spanish version
• How Often Should I Get a Mammogram? (ages 50-74) English version, Español/Spanish version
• Should I Get a Mammogram? (ages 75+) English version,  Español/Spanish version

Member Requests

• Member Request to Change Primary Care Provider

Member Appeals

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