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Access and Availability Standards

Adult Preventive Care Recommendations

Authorization List

Behavioral Health Authorization Request for Additional Visits

Behavioral Health Notification Form

Behavioral Health Report to PCP

Care Plan for Children with Complex Special Health Care Needs

Claim Appeal Submission Form

CMS-1500 Claim Form

Consent to Use Physician's Assistant/Nurse Practitioner

Explanation of Payment (EOP)

Member Education Request Form

Pediatric Preventive Care Recommendations

Physician Medical Record Audit Tool

Provider Appeal Form

Provider Complaint Form

Provider Request for Transfer Form

Psychological Testing Request Form

Quick Reference Guide

Request for Continuity/Transition of Care

Suspicious Activity Report (Member)

Suspicious Activity Report (Provider)

Texas Referral/Authorization Form

UB-04 Claim Form