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Access and Availability Standards

Adult Preventative Care Recommendations

Authorization List

Behavioral Health Report to PCP

Behavioral Health Request for Additional Visits

Blood Lead Screening and Testing Guidelines

Care Plan for Children with Complex Special

Category Codes and Type Programs

Claim Appeal Submission Form

CMS - 1500 Claim Form

Community First Member ID Card

Complex Neonate Acuity of Service Matrix

Consent to Use Physician's Assistant/Nurse Practitioner

Explanation of Payment (EOP)

Immunization Schedule (2011): Exhibit 27A - Recommended Immunization Schedule 0-6 Years of Age Exhibit 27B - Recommended Immunization Schedule 7-18 Years of Age Exhibit 27C - Catch-Up Immunization Schedule 4 Months - 18 Years Exhibit 27D - 2010 Recommended Adult Immunization Schedule

Infectious Disease Report

Medicaid Eligibility Verification Form (H1027-A)

Member - Client Acknowledgement Statement

Member Education Request Form

Periodicity Schedule: Exhibit 10 - THSteps Medical Checkups Periodicity Schedule (2011)

Exhibit 15A - PCP: 14.1 PCP Documentation Guidelines 2011 14.2 PCP Medical Record Review Tool 2011

Exhibit 15B - OB/Gyn: 18.4 OB-GYN Documentation Guidelines 2011 18.5 OB-GYN Medical Record Review Tool 2011

Exhibit 15C - Behavior Health: 07.1 Behavioral Health Documentation Guidelines 2011 07.2 Behavioral Health Medical Record Review Tool 2011

Exhibit 15D - Specialist: 14.3 Specialist Documentation Guidelines 2011 14.4 Specialist Medical Record Review Tool 2011

Private Pay Agreement

Provider Appeal Form

Provider Complaint Form

Provider Request for Transfer

Psychological Testing Request Form

Quick Reference Guide

Request for Continuity/Transition of Care

Request for Increase in 1500 CAPACITY

STAR Form 3087

Sterilization Consent

Suspicious Activity Report Form (Member)

Suspicious Activity Report Form (Provider)

Texas Referral/Authorization Form

Texas Vaccine for Children Form

Tuberculosis Report of Case and Patient Services

UB-04 Claim Form