Texas provider materials and forms

Provider manual (PDF)

Key phone numbers — English (PDF) | Spanish (PDF)

Shared decision-making aids are communication tools used as a way for providers and patients to make informed health care decisions based on what is important to the patient. They do not replace physician guidance but are intended to help complement the discussions between patients and physicians on treatment decisions.

Below are evidence-based aids that provide information about treatment options, lifestyle changes, and outcomes.

Asthma

Depression

Diabetes

• Standards of Care App | American Diabetes Association
• 6. Glycemic Targets: Standards of Care in Diabetes—2023 | Diabetes Care | American Diabetes Association (diabetesjournals.org)

Flu Prevention

Statin choice decision aid

Depression medicaition choice

Cardiovascular primary prevention choice

Home Health Services (Title XIX) DME Medical Supplies Physician Order Form (PDF)

Texas Medicaid Physical, Occupational, and Speech Therapy Prior Authorization Form (PDF)

CCP Prior Authorization Form (PDF)

Prospective provider form (PDF)

Health services PA request form (PDF)

Drug PA request form (PDF)

Private duty nursing PA request form (PDF)

Claims appeal form (PDF)

Claims reconsideration form (PDF)

CVS Caremark® mail service pharmacy order form — English (PDF) | Spanish (PDF)

Consent

In-Lieu-Of Services for Texas (ILOS) – Adult Partial Hospitalization Program and Intensive Outpatient Program (PDF)

Sterilization consent form — English (PDF) | Spanish (PDF)

Sterilization consent form instructions (PDF)

Authorization to release protected health information (PHI) (PDF)

Authorization to release psychotherapy notes (PDF)

Member acknowledgment form (PDF)

Private pay agreement form (PDF)

Physical, Occupational, or Speech Therapy (PT, OT, ST) Prior Authorization Form 

Request services

Durable medical equipment (DME) request form (PDF)

Extension of outpatient therapy request form (PDF)

Texas Medicaid and Healthcare Partnership (TMHP)

Texas Health and Human Services Commission (HHSC)

HHSC nursing facility unit rates

HHSC vendor drug program

Texas Health Steps

Texas Department of Family and Protective Services (DFPS)

Texas Office of the Inspector General

Access2Care portal for nonemergency medical transportation (NEMT) services

Aetna access to care guidelines (PDF)

Health Insurance Portability and Accountability Act (HIPAA) guidelines

American Academy of Pediatrics clinical practice guidelines