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 Compensation Enhancement Program (ACEP) Form - Please submit your form between August 1, 2024 and by 5 p.m. CT on October 1, 2024.
Care Provider Complaint Form
Critical Incident Reporting Form
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
Texas REACH nomination form

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

Medicaid Pre-Service Appeal or Grievance