Frequently Used Forms

Molina Allowed In-Office Lab Test List, Effective 1.1.18

Contract Request Form

Provider Demographic Survey

2016 ACE Instructions

2016 ACE Form - ICD10

2016 ACE Form - Never Existed and Resolved Conditions

LTSS & Home and Community Based Services Quick Reference Guide

 

Prior Authorization

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 Prior Authorization Guide-Medicare

2021 Prior Authorization Guide-Medicaid

Medicaid Prior Authorization Code Matrix

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

 

Claims

Claims Inquiry/Appeal Form


Provider Information


Other

Depression Screening- Provider Tip Sheet


TMHP Timely Filing Calendar 2015