Texas provider materials and forms

• Provider manual (PDF)
  
• Key phone numbers — English (PDF)
• Key phone numbers — 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)
• CVS Caremark® mail service pharmacy order form — Spanish (PDF)

Consent

• In-Lieu-Of Services for Texas (ILOS) – Adult Partial Hospitalization Program and Intensive Outpatient Program (PDF)
  
• Sterilization consent form — English (PDF)
• Sterilization consent form — 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