Frequently Used Forms

Molina Allowed In-Office Lab Test List, Effective 1.1.19

Contract Request Form

Change of Information Form

LTSS & Home and Community Based Services Quick Reference Guide

 

Prior Authorization

2022 Prior Authorization Guide - Medicare

Medicare Prior Authorization Request Form

Medicare Behavioral Health Prior Authorization Request Form

Medicare Pharmacy Prior Authorization Request Form

Provider News Bulletin Prior Authorization Code Matrix - May 2022

Provider News Bulletin Prior Authorization Code Matrix - March 2022

Provider News Bulletin Prior Authorization Code Matrix - November 2021

Provider News Bulletin Prior Authorization Code Matrix September 2021

Provider News Bulletin Prior Authorization Code Matrix- May 2021

Provider News Bulletin Prior Authorization Code Matrix- February 2021

Provider News Bulletin Prior Authorization Code Matrix - January 2021

Bulletin Prior Authorization Code Matrix - August 2020 - V2

Provider News Bulletin Prior Authorization Code Matrix - August 2020

Provider News Bulletin Prior Authorization Code Matrix - May 2020

Provider News Bulletin Prior Authorization Code Matrix - March 2020

Provider News Bulletin Prior Authorization Code Matrix - January 2020

Provider News Bulletin Prior Authorization Code Matrix - November 2019

Provider News Bulletin Prior Authorization Code Matrix - January 2020 Updates

Texas Standardized Prior Authorization Request Form for Health Care Services

Texas Standardized Prior Authorization Request Form for Prescription Drugs

2021 Q1 Prior Authorization Guide Code Matrix - Medicare

Historical Prior Authorization Code Matrix Update Log

Types of Medicaid Notifications

Medicaid Turn Around Times for Service Determinations

Behavioral Health Service Request Form

Pharmacy Prior Authorization Request Form - Medicare

Prior Authorization Request Form - Medicare

 

Claims

Claims Inquiry/Appeal Form


Provider Information


Other

Depression Screening- Provider Tip Sheet

TMHP Timely Filing Calendar 2022