Forms & Resources

Claims & Appeals

Provider Claim Appeal Request Process & Form

Refund Information Form

STAR Medicaid Member Appeal and Grievance Process

Medical Management

Coordination of Care/Treatment Summary Form

Newborn Notification Form

Network

Prospective Provider Form

Provider Action Form

Pharmacy

Direct Member Reimbursement Form

Non-Formulary Drug Coverage Form

Override Request Form

Synagis Form

Mail Order Form

Exception to Coverage Request Form

Resources

Fax Cover

Portal User Guide

Texas Medicaid & Healthcare Partnership

Prior Authorization Forms & Resources