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Access and Availability Standards

Authorization List

Behavioral Health Authorization Request for Additional Visits

Care Plan for Children with Complex Special Health Care Needs Form

CHIP Cost Sharing Schedule

Claim Appeal Submission Form

CMS - 1500 Claim Form

Community First CHIP Member ID Card

Explanation of Payment (EOP)

Member Education Request Form

Member/Client Acknowledgement Statement

Pediatric Preventive Care Recommendations

Physician Medical Record Audit Tool

Private Pay Agreement

Provider Appeal Form

Provider Complaint Form

Provider Request for Transfer

Quick Reference Guide

Request for Continuity Transition of Care Form

Suspicious Activity Report (Member)

Suspicious Activity Report (Provider)

TB Report of Case and Patient Services

Texas Referral/Authorization Form

Texas Vaccine for Children Form

UB-04 Claim Form