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Provider Forms | UnitedHealthcare Community Plan of Texas

See the items below to stay up-to-date with forms that are important to your practice.

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Completing Title XIX DME/Medical Supplies Form For Texas Medicaid Plans

Provider Forms

Attendant Rate Enhancement Form - The application deadline for the rate enhancement is November 1, 2023 at 5:00 p.m. CST.
Care Provider Complaint Form
Critical Incident Reporting Form
EVV Visit Maintenance Unlock Request for CDS Employers
EVV Vendor Provider Onboarding Form - First Data
EVV Vendor Provider Onboarding Form - Vesta EVV
HHSC’s Parent and Child Anticipatory Guidance and Health Education for Texas Health Steps Checkups
Medicaid Pre-Service Appeal or Grievance
Notification of pregnancy
Obstetrical risk assessment form
Prior Authorization Forms
Synagis Enrollment Form

Submit a Pre-Service Appeal and or Grievance for a Medicaid Member

Medicaid Pre-Service Appeal or Grievance