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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 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
EVV Visit Maintenance Unlock Request for CDS Employers
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