Texas Medicaid and CHIP - Uniform Managed Care Manual

Managed care is a system where the overall care of a patient is overseen by a single provider or organization as a way to improve quality and control costs. The manual below defines procedures that Managed Care Organizations (MCOs) must follow in order to meet certain requirements in the HHSC managed care contracts, and to provide interpretation on contractual provisions that need clarification.

People needing accessibility assistance with these documents should email HHSC Managed Care UMCM.

Uniform Managed Care Manual

Chapter 1

• Introduction (PDF)
• 1.1 – Materials Submitted for HHSC Review (PDF)

Chapter 2: Texas Claims Procedures

• 2.0 – Claims Manual (PDF)
• 2.1 – Uniform Billing for STAR+PLUS
  • 2.1.1 – Long Term Services and Supports Billing (withdrawn 3/20/15)
  • 2.1.2 – Long Term Services and Supports Codes and Modifiers (withdrawn 5/15/14)
  • 2.1.3 – STAR+PLUS Attendant Care Enhanced Payment Methodology (MS Word)
• 2.2 – Pharmacy Claims Manual (PDF)
• 2.3 – Nursing Facility Claims Manual (PDF)
• 2.4 – Medicaid National Correct Coding Initiative Requirement (PDF)

Chapter 3: Critical Elements

• 3.1 – MMC Provider Directory (MS Word)
• 3.2 – CHIP Provider Directory (MS Word)
• 3.3 – MMC/CHIP Provider Manual (MS Word)
• 3.4 – MMC Member Handbook (MS Word)
• 3.5 – CHIP Member Handbook (MS Word)
• 3.6 – MMC Member ID Card (MS Word)
• 3.7 – CHIP Member ID Card (MS Word)
• 3.8 – CHIP Perinate Member ID Card (MS Word)
• 3.9 – Integrated Care Management Provider Directory (withdrawn 9/10/09)
• 3.10 – Integrated Care Management Provider Manual (withdrawn 9/10/09)
• 3.11 – Integrated Care Management Member Handbook (withdrawn 9/10/09)
• 3.12 – Integrated Care Management Member ID (withdrawn 9/10/09)
• 3.13 – STAR Health Provider Directory (MS Word)
• 3.14 – STAR Health Provider Manual (MS Word)
• 3.15 – STAR Health Member Handbook (MS Word)
• 3.16 – STAR Health Member ID (MS Word)
• 3.17 – CHIP Dental Provider Directory (MS Word)
• 3.18 – MMC-CHIP Dental Provider Manual (MS Word)
• 3.19 – CHIP Dental Member Handbook (MS Word)
• 3.20 – CHIP Dental Member ID Card (MS Word)
• 3.21 – MMC / CHIP Service Authorization Notice Requirements (PDF)
  • 3.21.1 – Independent Review Organization Process (MS Word)
• 3.22 – Incomplete Prior Authorizations (PDF)
• 3.23 – STAR Health Dental Services Provider Manual (withdrawn 1/15/16)
• 3.24 – MMC Texas Health Steps Outreach Materials (PDF)
• 3.25 – MMC Dental Provider Directory (MS Word)
• 3.26 – Medicaid Dental Member Handbook (MS Word)
• 3.27 – Medicaid Dental Member ID Card (MS Word)
• 3.28 – Process for Resolution of HHSC-Referred Complaints (PDF)
  • 3.28.1 – Escalation Help Line Calls (PDF)
• 3.29 – MMC/CHIP MCO Pharmacy Website Required Critical Elements (PDF)
• 3.30 – MMC Nursing Facility Member Handbook (MS Word)
• 3.31 – MMC Nursing Facility Provider Manual (MS Word)
• 3.32 – MMC/CHIP Website Critical Elements (PDF)
• 3.33 – STAR Kids Provider Manual (MS Word)
• 3.34 – MMC-CHIP Online Provider Directory (PDF)
• 3.35 – Uniform Critical Elements Requirements (PDF)

Chapter 4: Marketing Policies and Procedures

• 4.1 – MMC Marketing Policies and Procedures (withdrawn 10/15/07)
• 4.2 – CHIP Marketing Policies and Procedures (withdrawn 10/15/07)
• 4.3 – Marketing and Member Materials Policy (PDF)
  • 4.3.1 – MCO Notification of a Medicaid Other Event Form Instructions (PDF)
  • 4.3.2 – MCO Notification of a Medicaid Other Event Form (MS Word)
• 4.4 – Dental Value-Added Services Template (MS Word)
• 4.5 – Physical and Behavioral Health Value-Added Services Template (MS Word)
• 4.6 – MCO Materials Submission Process (PDF)
  • 4.6.1 – MMC, CHIP, and DMO Marketing, Member, and Provider Materials Form Instructions (PDF)
  • 4.6.2 – MMC, CHIP, and DMO Marketing, Member, and Provider Materials Form (MS Word)
• 4.7 – Value-Added Services Instructions (PDF)
• 4.8 – MMP Flexible Benefits Template (MS Word)
• 4.9 – MMP Flexible Benefits Template Instructions (PDF)
• 4.10 – MMP Rewards and Incentives Template (MS Word)
• 4.11 – MMP Rewards and Incentives Instructions (PDF)
• 4.12 – Alleged Marketing Violations (PDF)
  • 4.12.1 – Medicaid/CHIP Managed Care Alleged Marketing Violation Form Instructions (PDF)
  • 4.12.2 – Medicaid/CHIP Managed Care Alleged Marketing Violation Form (MS Word)
• 4.13 – Social Media (PDF)
• 4.15 – Marketing Glossary of Terms (PDF)

Chapter 5: Deliverables, Report Formats, Due Dates

• 5.0 – Consolidated Deliverables Matrix (withdrawn 10/01/19)
  • 5.0.1 – Deliverable Requirements Matrix (PDF)
• 5.1 – Deliverables Naming Conventions (PDF)
  • 5.1.1 – Deliverables Codes (Excel)
• 5.2 – MIS Deliverables/Formats (Withdrawn 11/01/18)
• 5.3 – Financial Reports/Formats
  • 5.3.1 – FSR and Instructions
    • 5.3.1.1 – CHIP FSR Template for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.2 – CHIP FSR Instructions for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.3 – STAR FSR Template for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.4 – STAR FSR Instructions for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.5 – STAR+PLUS FSR Template for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.6 – STAR+PLUS FSR Instructions for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.7 – CHIP Perinatal FSR Template for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.8 – CHIP Perinatal FSR Instructions for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.9 – ICM ASO FSR (withdrawn 1/1/10)
    • 5.3.1.10 – ICM ASO FSR Instructions (withdrawn 1/1/10)
    • 5.3.1.11 – STAR Health FSR Template for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.12 – STAR Health FSR Instructions for transactions occurring prior to 3/1/12 (withdrawn 9/1/13)
    • 5.3.1.13 – CHIP Dental FSR for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.14 – CHIP Dental FSR Instructions for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.15 – Medicaid Dental FSR for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.16 – Medicaid Dental FSR Instructions for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.17 – Admin FSR Template for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.18 – Admin FSR Instructions for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.19 – CHIP FSR Template for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.20 – CHIP FSR Instructions for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.21 – STAR FSR Template for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.22 – STAR FSR Instructions for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.23 – STAR MRSA FSR Template for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.24 – STAR MRSA FSR Instructions for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.25 – STAR+PLUS FSR Template for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.26 – STAR+PLUS FSR Instructions for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.27 – STAR Health FSR Template for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.28 – STAR Health FSR Instructions for transactions occurring prior to 9/1/13 (withdrawn 12/9/14)
    • 5.3.1.29 – CHIP Dental FSR Template for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.30 – CHIP Dental FSR Instructions for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.31 – Medicaid Dental FSR Template for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.32 – Medicaid Dental FSR Instructions for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.33 – Admin FSR Template for transactions occurring on or after 9/1/13 and prior to 9/1/16 (withdrawn 10/22/18)
    • 5.3.1.34 – Admin FSR Instructions for transactions occurring on or after 9/1/13 and prior to 9/1/16 (withdrawn 10/22/18)
    • 5.3.1.35 – CHIP FSR Template for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.36 – CHIP FSR Instructions for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.37 – STAR FSR Template for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.38 – STAR FSR Instructions for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.39 – STAR MRSA FSR Template for MCOs participating in MRSA at 9/1/13 and related transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.40 – STAR MRSA FSR Instructions for MCOs participating in MRSA at 9/1/13 and related transactions occurring on or after 9/1/13 and prior to 9/1/14 9 (withdrawn 9/1/16)
    • 5.3.1.41 – STAR+PLUS FSR Template for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.42 – STAR+PLUS FSR Instructions for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.43 – STAR Health FSR Template for transactions occurring on or after 9/1/13 and prior to 9/1/14 (withdrawn 9/1/16)
    • 5.3.1.45 – STAR+PLUS FSR Template for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.46 – STAR+PLUS FSR Instructions for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.47 – Dual Demonstration FSR Template (Excel) for transactions occurring prior to 9/1/16
    • 5.3.1.48 – Dual Demonstration FSR Instructions (PDF) for transactions occurring prior to 9/1/16
    • 5.3.1.49 – STAR FSR Template for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.50 – STAR FSR Instructions for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.51 – CHIP FSR Template for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.52 – CHIP FSR Instructions for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.53 – CHIP Dental FSR Template for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.54 – CHIP Dental FSR Instructions for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.55 – Medicaid Dental FSR Template for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.56 – Medicaid Dental FSR Instructions for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.57 – STAR Health FSR Template for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.58 – STAR Health FSR Instructions for transactions occurring on or after 9/1/14 and prior to 9/1/16 (withdrawn 01/25/19)
    • 5.3.1.59 – STAR Kids FSR Template (Excel) for transactions occurring on or after 9/1/18
    • 5.3.1.60 – STAR Kids FSR Instructions (PDF) for transactions occurring on or after 9/1/18
    • 5.3.1.61 – Quality Improvement Costs FSR Template (Excel) for transactions occurring on or after 9/1/16 and prior to 9/1/18
    • 5.3.1.62 – Quality Improvement Costs (PDF) for transactions occurring on or after 9/1/16 and prior to 9/1/18
    • 5.3.1.63 – STAR+PLUS FSR Template (Excel) for transactions occurring on or after 9/1/16
    • 5.3.1.64 – STAR+PLUS FSR Instructions (PDF) for transactions occurring on or after 9/1/16
    • 5.3.1.65 – Admin FSR Template (Excel) for transactions occurring on or after 9/1/16 and prior to 9/1/18
    • 5.3.1.66 – Admin FSR Instructions (PDF) for transactions occurring on or after 9/1/16 and prior to 9/1/18
    • 5.3.1.67 – STAR FSR Template for transactions (Excel) occurring on or after 9/1/16
    • 5.3.1.68 – STAR FSR Instructions for transactions (PDF) occurring on or after 9/1/16
    • 5.3.1.69 – CHIP FSR Template (Excel) for transactions occurring on or after 9/1/18
    • 5.3.1.70 – CHIP FSR Instructions (PDF) for transactions occurring on or after 9/1/18
    • 5.3.1.71 – CHIP Dental FSR Template (Excel) for transactions occurring on or after 9/1/16 and prior to 9/1/18
    • 5.3.1.72 – CHIP Dental FSR Instructions (PDF) for transactions occurring on or after 9/1/16 and prior to 9/1/18
    • 5.3.1.73 – Medicaid Dental FSR Template (Excel) for transactions occurring on or after 9/1/16 and prior to 9/1/18
    • 5.3.1.74 – Medicaid Dental FSR Instructions (PDF) for transactions occurring on or after 9/1/16 and prior to 9/1/18
    • 5.3.1.75 – STAR Health FSR Template (Excel) for transactions occurring on or after 9/1/18
    • 5.3.1.76 – STAR Health FSR Instructions (PDF) for transactions occurring on or after 9/1/18
    • 5.3.1.77 – Dual Demonstration (Excel) (MMP) FSR Template for transactions occurring on or after 9/1/17
    • 5.3.1.78 – Dual Demonstration (PDF) (MMP) FSR Instructions for transactions occurring on or after 9/1/17
    • 5.3.1.79 – STAR FSR Template (Excel) for transactions occurring on or after 9/1/18
    • 5.3.1.80 – STAR FSR Instructions (PDF) for transactions occurring on or after 9/1/18
    • 5.3.1.81 – STAR+PLUS FSR (Excel) Template for transactions occurring on or after 9/1/18
    • 5.3.1.82 – STAR+PLUS FSR (PDF) Instructions for transactions occurring on or after 9/1/18
    • 5.3.1.83 – Combined Admin and QI FSR Template (Excel) for transactions occurring on or after 9/1/18.
    • 5.3.1.84 – Combined Admin and QI FSR Instructions (PDF) for transactions occurring on or after 9/1/18.
    • 5.3.1.85 – CHIP Dental Services Program FSR Template (Excel) for transactions occurring on or after 9/1/18
    • 5.3.1.86 – CHIP Dental Services Program FSR Instruction (PDF) for transactions occurring on or after 9/1/18
    • 5.3.1.87 – Children's Medicaid Dental Services Program FSR Template (Excel) for transactions occurring on or after 9/1/18
    • 5.3.1.88 – Children's Medicaid Dental Services Program FSR Instructions (PDF) for transactions occurring on or after 9/1/18
    • 5.3.1.89 – STAR FSR Template (Excel) for transactions occurring on or after 9/1/20
    • 5.3.1.90 – STAR FSR Instructions (PDF) for transactions occurring on or after 9/1/20
    • 5.3.1.91 – STAR Kids FSR Template (Excel) for transactions occurring on or after 9/1/20
    • 5.3.1.92 – STAR Kids FSR Instructions (PDF) for transactions occurring on or after 9/1/20
    • 5.3.1.93 – STAR+PLUS FSR Template (Excel) for transactions occurring on or after 9/1/20
    • 5.3.1.94 – STAR+PLUS FSR Instructions (PDF) for transactions occurring on or after 9/1/20
    • 5.3.1.95 – STAR Health FSR Template (Excel) for transactions occurring on or after 9/1/20
    • 5.3.1.96 – STAR Health FSR Instructions (PDF) for transactions occurring on or after 9/1/20
    • 5.3.1.97 – Dual Demonstration (MMP) FSR Template (Excel) for transactions occurring on or after 9/1/20
    • 5.3.1.98 – Dual Demonstration (MMP) FSR Instructions (PDF) for transactions occurring on or after 9/1/20
    • 5.3.1.99 – STAR Financial Statistical Report (FSR) Template (Excel)
    • 5.3.1.100 – STAR Financial Statistical Report (FSR) Instructions (PDF)
    • 5.3.1.101 – STAR Kids Financial Statistical Report (FSR) Template (Excel)
    • 5.3.1.102 – STAR KIDS Financial Statistical Report (FSR) Instructions (PDF)
    • 5.3.1.103 – STAR+PLUS Financial Statistical Report (FSR) Template (Excel)
    • 5.3.1.104 – STAR+PLUS Financial Statistical Report (FSR) Instructions (PDF)
    • 5.3.1.105 – STAR HEALTH Financial Statistical Report (FSR) Template (Excel)
    • 5.3.1.106 – STAR Health Financial Statistical Report (FSR) Instructions (PDF)
    • 5.3.1.107 – CHIP Financial Statistical Report (FSR) Template (Excel)
    • 5.3.1.108 – CHIP Financial Statistical Report (FSR) Instructions (PDF)
    • 5.3.1.109 – Children's Medicaid Dental Services Program Financial Statistical Report (FSR) Template (Excel)
    • 5.3.1.110 – Children’s Medicaid Dental Services Program Financial Statistical Report (FSR) Instructions (PDF)
    • 5.3.1.111 – CHIP Dental Services Program Financial Statistical Report (FSR) Template (Excel)
    • 5.3.1.112 – CHIP Dental Services Program Financial Statistical Report (FSR) Instructions (PDF)
    • 5.3.1.113 – STAR+PLUS FINANCIAL STATISTICAL REPORT (FSR) TEMPLATE (Excel)
    • 5.3.1.114 – STAR +PLUS Financial Statistical Report (FSR) Instructions (PDF)
  • 5.3.2 - MCO Disclosure Statement (MS Word)
    • 5.3.2.1 – MCO Disclosure Statement Change Notification (MS Word)
  • 5.3.3 – CMS 1513 Report (withdrawn 6/15/11)
  • 5.3.4 – Third Party Liability and Recoveries (TPL/TPR)
    • 5.3.4.1 – TPL/TPR Report (Excel)
    • 5.3.4.2 – TPL/TPR Report Instructions (PDF)
    • 5.3.4.3 – Dual Demo TPL/TPR Report (Excel)
    • 5.3.4.4 – Dual Demo TPL/TPR Report Instructions (PDF)
    • 5.3.4.5 – TPR MCO Referral Form (Excel)
    • 5.3.4.6 – TPR MCO Billing/Posting File (Excel)
    • 5.3.4.7 – Third Party Liability: Managed Care Organization Action Plan; Dental Contractor Action Plan (Excel)
    • 5.3.4.8 – TPL MCO Pharmacy Report (Excel)
    • 5.3.4.9 – TPR MCO Pharmacy Billing/Posting File (Excel)
    • 5.3.4.10 – TPR Managed Care Recovery Payment Submission Requirements (MS Word)
    • 5.3.4.11 – TPR MCO Pharmacy Referral File (Excel)
  • 5.3.5 – Delivery Supplemental Payment (DSP) Report
    • 5.3.5.1 – DSP CHIP Format (Excel)
    • 5.3.5.2 – DSP Medicaid Format (Excel)
    • 5.3.5.3 – DSP File Submission Instructions (PDF)
    • 5.3.5.4 – DSP File Specifications (Excel)
    • 5.3.5.5 – DSP Appeal Form CHIP (Excel)
    • 5.3.5.6 – DSP Appeal Form Medicaid (Excel)
  • 5.3.6 – FQHC Report and Instructions
    • 5.3.6.1 – FQHC Template (withdrawn 9/1/13)
    • 5.3.6.2 – FQHC Instruction (withdrawn 9/1/13)
  • 5.3.7 – RHC Report and Instructions
    • 5.3.7.1 – RHC Template (withdrawn 2/10/11)
    • 5.3.7.2 – RHC Instruction (withdrawn 2/10/11)
  • 5.3.8 – OON Utilization Report (withdrawn 7/15/20)
    • 5.3.8.1 – OON Utilization Report Instructions (withdrawn 7/15/20)
  • 5.3.9 – Disproportionate Share Hospital Report
    • 5.3.9.1 – Disproportionate Share Hospital Report Instructions (withdrawn 3/1/13)
    • 5.3.9.2 – Disproportionate Share Hospital Report Template (withdrawn 3/1/13)
  • 5.3.10 – Data Certification
    • 5.3.10.1 – Data Certification Form (Excel)
    • 5.3.10.2 – Data Certification Instructions (PDF)
  • 5.3.11 – Audit Reports (PDF)
  • 5.3.12 – Bariatric Supplemental Payment (BSP) Report
    • 5.3.12.1 – Medicaid BSP Instructions (withdrawn 9/1/13)
    • 5.3.12.2 – Medicaid BSP Report Format (withdrawn 9/1/13)
    • 5.3.12.3 – Medicaid BSP Appeals Form (withdrawn 9/1/13)
  • 5.3.13 – Medical Loss Ratio (MLR) Report
    • 5.3.13.1 – Medical Loss Ratio (MLR) Report Instructions (PDF)
    • 5.3.13.2 – Medical Loss Ratio (MLR) Template (Excel)
    • 5.3.13.3 – Dual Demonstration Medical Loss Ratio (MLR) Instructions (PDF)
    • 5.3.13.4 – Dual Demonstration Medical Loss Ratio (MLR) Template (Excel)
    • 5.3.13.5 - Dental Maintenance Organization (DMO) Medical Loss Ratio (MLR) Report Instructions (PDF)
    • 5.3.13.6 - Dental Maintenance Organization (DMO) Medical Loss Ratio (MLR) Report Template (Excel)
• 5.4 – Operational Deliverable/Report Formats
  • 5.4.1 – Provider Network Reports
    • 5.4.1.1 – Provider Termination Report (withdrawn 2/1/16)
    • 5.4.1.2 – CHIP PCP Network and Capacity Report (withdrawn 2/1/16)
    • 5.4.1.3 – STAR Health PCP TH Steps Enrollment Report (Excel)
    • 5.4.1.4 – STAR Health Network Summary Report (Excel)
    • 5.4.1.5 – Dental Provider Termination Report (withdrawn 2/1/16)
    • 5.4.1.6 – Main Dental Home Network and Capacity Report (withdrawn 2/1/16)
    • 5.4.1.7 – MMC Pharmacy Network Report (withdrawn 9/1/14)
    • 5.4.1.8 – CHIP Pharmacy Network Report (withdrawn 9/1/14)
    • 5.4.1.9 – Provider Enrollment/Credentialing Denial Report (withdrawn 2/14/20)
    • 5.4.1.10 – Provider Network Examination Report (Excel)
    • 5.4.1.11 – Provider Termination Report (withdrawn 7/15/20)
    • 5.4.1.12 – Network and Capacity Report (withdrawn 7/15/20)
    • 5.4.1.13 – After-Hours Provider Accessibility Report (Excel)
    • 5.4.1.14 – After-Hours Provider Accessibility Report Instructions (PDF)
  • 5.4.2 – Complaints and Appeals Report
    • 5.4.2.1 – CHIP Member Appeals (withdrawn 2/1/16)
    • 5.4.2.2 – CHIP Overturned (withdrawn 9/1/06)
    • 5.4.2.3 – Medicaid Member Appeals (withdrawn 2/1/16)
    • 5.4.2.4 – Medicaid Overturned (withdrawn 9/1/06)
    • 5.4.2.5 – Member Complaint Report (withdrawn 2/1/16)
    • 5.4.2.6 – Provider Complaint Report (withdrawn 2/1/16)
    • 5.4.2.7 – CHIP Dental Program Member Appeals (withdrawn 2/1/16)
    • 5.4.2.8 – CHIP Dental Program Member Complaints (withdrawn 2/1/16)
    • 5.4.2.9 – CHIP Dental Program Provider Complaints (withdrawn 2/1/16)
    • 5.4.2.10 – CHIP Dental Program Overturned (withdrawn 8/10/12)
    • 5.4.2.11 – Medicaid Dental Member Appeals (withdrawn 2/1/16)
    • 5.4.2.12 – Medicaid Dental Member Complaints (withdrawn 2/1/16)
    • 5.4.2.13 – Medicaid Dental Provider Complaints (withdrawn 2/1/16)
    • 5.4.2.14 – Medicaid Dental Overturned (withdrawn 8/10/12)
    • 5.4.2.15 – Nursing Facility Complaints and Appeals Report Template (withdrawn 7/15/20)
    • 5.4.2.16 – Nursing Facility Complaints and Appeals Report Instructions (withdrawn 7/15/20)
    • 5.4.2.17 – Member Complaints (withdrawn 7/15/20)
    • 5.4.2.18 – Provider Complaints (withdrawn 7/15/20)
    • 5.4.2.19 – Member Appeals (withdrawn 7/15/20)
    • 5.4.2.20 – Reduction, Denial, Termination of Items/Services Report (withdrawn 6/15/18)
  • 5.4.3 – Hotline Reports
    • 5.4.3.1 – Behavioral Health Hotline Report (withdrawn 2/1/16)
    • 5.4.3.2 – Member Hotline Status (withdrawn 2/1/16)
    • 5.4.3.3 – Provider Hotline Status (withdrawn 2/1/16)
    • 5.4.3.4 – STAR Health BH Services Hotline Report (withdrawn 2/1/16)
    • 5.4.3.5 – STAR Health Member Services Hotline Report (withdrawn 2/1/16)
    • 5.4.3.6 – STAR Health Provider Hotline Status (withdrawn 2/1/16)
    • 5.4.3.7 – STAR Health Nurse Hotline Report (withdrawn 2/1/16)
    • 5.4.3.8 – CHIP Dental Member Hotline (withdrawn 2/1/16)
    • 5.4.3.9 – CHIP Dental Provider Hotline (withdrawn 2/1/16)
    • 5.4.3.10 – Medicaid Dental Provider Hotline (withdrawn 2/1/16)
    • 5.4.3.11 – Medicaid Dental Member Hotline (withdrawn 2/1/16)
    • 5.4.3.12 – Member Services Hotline Report (withdrawn 7/15/20)
    • 5.4.3.13 – Provider Hotline Report (withdrawn 7/15/20)
    • 5.4.3.14 – BH Services Hotline Report (withdrawn 7/15/20)
    • 5.4.3.15 – Nurse Hotline Report (withdrawn 7/15/20)
  • 5.4.4 – HUB Reports
    • 5.4.4.1 – HUB Report Format (withdrawn 1/5/15)
    • 5.4.4.2 – HUB Status Determination Form (withdrawn 12/15/10)
    • 5.4.4.3 – HUB Best Practices Report Instructions (withdrawn 1/5/15)
    • 5.4.4.4 – HUB Progress Assessment Report Form (Excel)
    • 5.4.4.5 – HUB Progress Assessment Report Instructions (PDF)
    • 5.4.4.6 – HUB Change Request Instructions (PDF)
    • 5.4.4.7 – HUB Portal PAR Instructions (PDF)
  • 5.4.5 – LTSS Utilization Reports
    • 5.4.5.1 – STAR+PLUS Quarterly CDS Utilization Report (withdrawn 4/28/23)
    • 5.4.5.2 – STAR+PLUS Service Coordination Report(withdrawn 9/1/16)
    • 5.4.5.3 – STAR+PLUS PAS Authorizations and Billed Units (Excel)
    • 5.4.5.4 – STAR Kids Quarterly CDS Utilization Report (withdrawn 4/28/23)
    • 5.4.5.5 – STAR Kids Service Coordination Report(withdrawn 9/1/16)
    • 5.4.5.6 – STAR Kids PAS Authorizations and Billed Units (Excel)
    • 5.4.5.8 – MDCP PDN PPECC Authorization (Excel)
    • 5.4.5.9 – PCS CFC Authorization Report (withdrawn 9/11/18)
    • 5.4.5.10 – Relocations Functions Report (Excel)
  • 5.4.6 – MSHCN Reports
    • 5.4.6.1 – MSHCN Report (withdrawn 5/19/23)
    • 5.4.6.2 – MSHCN Report Instructions (withdrawn 5/19/23)
  • 5.4.7 – Utilization Review
    • 5.4.7.1 – Prior Authorizations Aggregated Monthly Measures (withdrawn 6/24/22)
    • 5.4.7.2 – Authorization Member-Level Data Guidelines and Reporting Instructions (PDF)
• 5.5 – Office of Inspector General
  • 5.5.1 – Deliverables to the Office of Inspector General (PDF)
  • 5.5.2 – MCO Open Case List Report (PDF)
• 5.6 – Claims Deliverables and Format
  • 5.6.1 – Claims Summary Report
    • 5.6.1.10 – Claims Summary Report Template (withdrawn 1/24/20)
    • 5.6.1.11 – Claims Summary Report Instructions (withdrawn 1/24/20)
  • 5.6.2 – Claims Lag Reports
    • 5.6.2.1 – CHIP Claims Lag Report Template (Excel) for transactions occurring prior to 9/1/15
    • 5.6.2.2 – STAR Claims Lag Report Template for transactions occurring prior to 9/1/13 (withdrawn 9/1/15)
    • 5.6.2.3 – STAR+PLUS Claims Lag Report Template (Excel)
    • 5.6.2.4 – Claims Lag Report Instructions (PDF)
    • 5.6.2.5 – STAR Health Claims Lag Report Template (Excel)
    • 5.6.2.6 – STAR Health Claims Lag Report Instructions (PDF)
    • 5.6.2.7 – CHIP Dental Claims Lag Report Template (Excel)
    • 5.6.2.8 – Dental Claims Report Instructions (PDF)
    • 5.6.2.9 – Medicaid Dental Claims Lag Report (Excel)
    • 5.6.2.10 – STAR MRSA Claims Lag Report Template for transactions occurring prior to 9/1/13 (withdrawn 9/1/15)
    • 5.6.2.11 – STAR Claims Lag Report Template (Excel) for transactions occurring on or after 9/1/13
    • 5.6.2.12 – STAR MRSA Claims Lag Report Template for transactions occurring on or after 9/1/13 (withdrawn 3/1/17)
    • 5.6.2.13 – CHIP Claims Lag Report Template (Excel) for transactions occurring on or after 9/1/15
    • 5.6.2.14 – STAR Kids Claims Lag Report Template (Excel)
    • 5.6.2.16 – Dual Demonstration Claims Lag Report Template (Excel)
    • 5.6.2.17 – Dual Demonstration Claims Lag Report Instructions (PDF)
    • 5.6.2.18 – STAR+PLUS Claims Lag Report (Excel)
  • 5.6.3 – Claims Projects Report (Excel)
• 5.7 – Quality Reports
  • 5.7.1 – QIP-QAPI Summary Format (MS Word)
  • 5.7.2 – Dual Demonstration QAPI Report (MS Word)
  • 5.7.3 – STAR Health MDCP Self-Reported Metrics Template (Excel)
    • 5.7.3.1 – STAR Health MDCP Measures Technical Specifications (PDF)
  • 5.7.4 – STAR Kids MDCP Self-Reported Metrics Template (Excel)
    • 5.7.4.1 – STAR Kids MDCP Measures Technical Specifications (PDF)
• 5.8 – Report of Legal and Other Proceedings (PDF)
• 5.9 – STAR Health Reports
  • 5.9.1 – STAR Health Liaison Summary Report (Excel)
  • 5.9.2 – STAR Health PMUR Report (Excel)
  • 5.9.3 – STAR Health Service Management Summary Report (withdrawn 8/10/23)
  • 5.9.4 – STAR Health CANS Assessment Summary Report (Excel)
• 5.10 – CHIP Craniofacial Anomalies Report
  • 5.10.1 – CHIP Craniofacial Anomalies Quarterly Report Instructions (withdrawn 1/15/14)
  • 5.10.2 – CHIP Craniofacial Anomalies Pre and Post Surgical Orthodontic Procedures Quarterly Report Template (withdrawn 1/15/14)
• 5.11 – Affiliate Report (PDF)
  • 5.11.1 – Affiliate Report Template (Excel)
• 5.12 – Federal Reports
  • 5.12.1 – CHIP Federal Report (withdrawn 9/1/17)
  • 5.12.2 – CMS T-MSIS X12 835 Data File Submission Requirements (PDF)
• 5.13 – Pharmacy Reports
  • 5.13.1 – MCO Drug Utilization Review (DUR) Quarterly Report Template (withdrawn 9/1/14)
  • 5.13.2 – MCO DUR Quarterly Report Instructions (withdrawn 9/1/14)
  • 5.13.3 – Pharmaceutical Delivery Fee Payment Methodology (MS Word)
  • 5.13.4 – MCO Quarterly Pharmacy Report Template (Excel)
  • 5.13.5 – MCO Quarterly PMUR Report Template (withdrawn 3/8/19)
  • 5.13.6 – Clinical PA Criteria Implementation Report (Excel)
  • 5.13.7 – PMUR Utilization Review Plan and Report (Excel)
  • 5.13.8 – Medication Synchronization Plan Template (MS Word)
  • 5.13.9 – Maximum Allowable Cost (MAC) List Timely Review and Modification Attestation (withdrawn 1/3/22)
• 5.14 – Geo-Mapping Reports
  • 5.14.1 – STAR Geo-Mapping Report (withdrawn 6/1/15)
  • 5.14.2 – STAR+PLUS Geo-Mapping Report (withdrawn 6/1/15)
• 5.15 – Special Exception Request Template for Variance from Out-of-Network Utilization Standards (MS Word)
• 5.16 – Perinatal Risk Report (withdrawn 5/4/22)
• 5.17 – NAIP Reports
  • 5.17.1 – NAIP Quarterly Report Template (withdrawn 9/6/22)
  • 5.17.2 – STAR NAIP Worksheet (withdrawn 9/6/22)
  • 5.17.3 – STAR NAIP Worksheet Instructions (withdrawn 9/6/22)
  • 5.17.4 – STAR+PLUS NAIP Worksheet (withdrawn 9/6/22)
  • 5.17.5 – STAR+PLUS NAIP Worksheet Instructions (withdrawn 9/6/22)
• 5.18 – Critical Incidents and Abuse, Neglect, and Exploitation Quarterly Report (withdrawn 8/25/23)
  • 5.18.1 – STAR Kids MDCP ANE Technical Specifications (withdrawn 8/25/23)
  • 5.18.2 – STAR Health MDCP ANE Technical Specifications (withdrawn 8/25/23)
• 5.20 – QIPP Timely Payments Attestation (MS Word)
• 5.21 – MCO Material Subcontractor Monitoring Calendar (Excel)
  • 5.21.1 – Delegated Entity and Third-Party Administrator Monitoring Requirements (PDF)
• 5.22 – Submission to HHSC of copies of certain Pre-existing External Reports (PDF)
• 5.23 – Executive Contact List (withdrawn 10/8/21)
• 5.24 – Text File Layouts
  • 5.24.1 – Claims Summary Report Text File Layout (Excel)
  • 5.24.2 – Network and Capacity Text File Layout (Excel)
  • 5.24.3 – Provider Termination Report Text File Layout (Excel)
  • 5.24.4 – Out-of-Network Utilization Report Text File Layout (Excel)
  • 5.24.5 – Member and Provider Complaints Text File Layout (Excel)
  • 5.24.6 – Member Appeals Report Text File Layout (Excel)
  • 5.24.7 – MCO Hotlines Report Text File Layout (Excel)
  • 5.24.8 – Dental Anesthesia Prior Authorization Report Text File Layout (Excel)
  • 5.24.9 – Claims Overpayment Text File Layout (Excel)
  • 5.24.10 – Service Coordination Report Text File Layout (Excel)
  • 5.24.11 – Critical Incidents and Abuse, Neglect, and Exploitation Text File Layout (Excel)
  • 5.24.12 – NEMT Trip Activity (Excel)
  • 5.24.13 – STAR Health 3 in 30 Assessments Text File Layout (Excel)
  • 5.24.14 – Non-Medical Needs Screening Report Text File Layout (Excel)
• 5.25 – Non-Compliance Summary Reports
  • 5.25.1 – 30 Day Deliverable Non-Compliance Summary (MS Word)
    • 5.25.1.1 – 30 Day Deliverable Non-Compliance Summary Instructions (PDF)
  • 5.25.2 – 45 Day Deliverable Non-Compliance Summary (MS Word)
    • 5.25.2.1 – 45 Day Deliverable Non-Compliance Summary Instructions (PDF)
  • 5.25.3 – Quarterly Deliverable Non-Compliance Summary (MS Word)
    • 5.25.3.1 – Quarterly Deliverable Non-Compliance Summary Instructions (PDF)
• 5.26 – Contract Requirements Matrix Checklist
  • 5.26.1 – STAR Kids Section 7 – Transitional Phase Requirements (Excel)
  • 5.26.2 – STAR Kids Section 8 – Operational Phase Requirements (Excel)
  • 5.26.3 – STAR Kids Section 9 – Turnover Requirements (Excel)
  • 5.26.4 – STAR Kids Section 12 – Remedies and Disputes Requirements (Excel)
  • 5.26.5 – STAR Health Section 7 – Transitional Phase Requirements (Excel)
  • 5.26.6 – STAR Health Section 8 – Operational Phase Requirements (Excel)
  • 5.26.7 – STAR Health Section 9 – Turnover Requirements (Excel)
  • 5.26.8 – STAR Health Section 12 – Remedies and Disputes Requirements (Excel)
  • 5.26.9 – Dental Services Section 2.2 – Transition Phase Requirements (Excel)
  • 5.26.10 – Dental Services Section 2.3 – Operations Phase Requirements (Excel)
  • 5.26.11 – Dental Services Section 2.8 – Turnover Requirements (Excel)
  • 5.26.12 – Dental Services Article 12 – Remedies and Disputes Requirements (Excel)
• 5.27 – Prior Authorization Annual Review Deliverable (Excel)
• 5.28 – Network Adequacy
  • 5.28.1 – Access to Network Providers Performance Standards and Specifications (Excel)

Chapter 6: Financial

• 6.1 – Cost Principles for Expenses (PDF)
• 6.2 – Financial Incentive Methodology
  • 6.2.1 – Performance Measures for Capitation Rate At Risk (withdrawn 9/1/16)
  • 6.2.2 – Performance Measures for Capitation Rate At-Risk Instructions (withdrawn 9/1/16)
  • 6.2.3 – Geo-Mapping Provider Layouts (withdrawn 3/1/17)
  • 6.2.4 – Geo-Mapping Methodology (withdrawn 3/1/17)
  • 6.2.5 – STAR Health 1% At Risk Premium (withdrawn 10/12/09)
  • 6.2.6 – Quality Challenge Award Performance Indicators (withdrawn 8/1/16)
  • 6.2.7 – Medicaid Dental Pay for Quality (P4Q) Program Measures (withdrawn 4/18/22)
  • 6.2.8 – CHIP Dental Pay for Quality (P4Q) Program Measures (withdrawn 4/18/22)
  • 6.2.9 – Medicaid Dental Quality Challenge Award (withdrawn 12/1/13)
  • 6.2.10 – CHIP Dental Quality Challenge Award (withdrawn 12/1/13)
  • 6.2.11 – Performance Measures for Pay for Quality (P4Q) (withdrawn 10/3/17)
  • 6.2.12 – Medicaid/CHIP Pay for Quality (P4Q) Technical Specifications (withdrawn 10/3/17)
  • 6.2.13 – Dental Pay for Quality (P4Q) Program Methodology (withdrawn 09/16/19)
  • 6.2.14 – Medical Pay-for-Quality (P4Q) Program (PDF)
  • 6.2.15 – Dental Pay-for-Quality (P4Q) Program (PDF)
  • 6.2.16 – QIPP Payment Validation (withdrawn 3/8/19)
  • 6.2.17 – Aligning Technology by Linking Interoperable Systems (ATLIS) Program Data Reporting Tool (Excel)
• 6.3 – CHIP Cost Sharing (PDF)
• 6.4 – Performance Bonds
  • 6.4.1 – Performance Bond Instructions (PDF)
  • 6.4.2 – STAR Performance Bond (withdrawn 9/15/09)
  • 6.4.3 – STAR+PLUS Performance Bond (withdrawn 9/15/09)
  • 6.4.4 – CHIP Performance Bond (withdrawn 9/15/09)
  • 6.4.5 – MMC/CHIP Performance Bond (MS Word)

Chapter 7: Management Information Systems (MIS)

• 7.1 – Joint Interface Plans (JIP) (PDF)
• 7.2 – MCOHub (PDF)
  • 7.2.1 – MCOHub Employee Access List (Excel)

Chapter 8: Provider

• 8.1 – Provider Contract Checklist (PDF)
• 8.2 – Medicaid/CHIP Out-of-Network Rules (PDF)
• 8.3 – Long-Term Services and Supports Provider Layout (withdrawn 8/4/23)
• 8.4 – Plan for Value-Based Contracting (withdrawn 11/1/16)
• 8.5 – Plan for Value-Based Contracting Worksheet (withdrawn 11/1/16)
• 8.6 – State Mandated Requirements for STAR+PLUS Nursing Facility Providers (PDF)
• 8.7 – Electronic Visit Verification
  • 8.7.1 – Electronic Visit Verification Requirements (PDF)
  • 8.7.2 – EVV MCO Quarterly Performance Measures Report (Excel)
• 8.10 – Alternative Payment Model Data Collection Tool (Excel)
• 8.11 – STAR + PLUS Nursing Facility Minimum Performance Standards (PDF)

Chapter 9: Disease Management (DM)

• 9.1 – Disease Management Requirement for STAR, CHIP, STAR Kids, and STAR+PLUS (PDF)
• 9.2 – ICM Disease Management Requirements (withdrawn 9/10/09)
• 9.3 – STAR Health Disease Management Requirements (PDF)

Chapter 10: Contract Management Tools

• 10.1 – Performance Indicator Dashboard
  • 10.1.1 – Performance Indicator Dashboard for Administrative and Financial Measures (withdrawn 1/15/16)
  • 10.1.2 – Information Pertaining to the Performance Indicator Dashboard (withdrawn 4/15/11)
  • 10.1.3 – STAR Health Performance Indicator Dashboard for Administrative and Financial Measures (withdrawn 9/1/16)
  • 10.1.4 – CHIP Dental Dashboard for Administrative and Financial Measures (withdrawn 9/1/16)
  • 10.1.5 – Medicaid Dental Dashboard - Admin and Financial Measures (withdrawn 9/1/16)
  • 10.1.7 – Performance Indicator Dashboard for Quality Measures (withdrawn 6/1/18)
  • 10.1.8 – STAR Health Performance Indicator Dashboard for Quality Measures (withdrawn 6/1/18)
  • 10.1.9 – CHIP Dental Performance Indicator Dashboard for Quality Measures (withdrawn 6/1/18)
  • 10.1.10 – Medicaid Dental Dashboard for Quality Measures (withdrawn 6/1/18)
  • 10.1.11 – LTSS Quality Measures Template (Excel) (withdrawn 4/29/24)
  • 10.1.12 – LTSS Quality Measures Technical Specifications (MS Word) (withdrawn 4/29/24)
  • 10.1.13 – STAR Kids Performance Indicator Dashboard for Quality Measures (withdrawn 6/1/18)
  • 10.1.14 – Performance Indicator Dashboard for Quality Measures (PDF)
• 10.2 – Performance Improvement
  • 10.2.1 – Performance Improvement Goal – Sub-Goal Template (withdrawn 9/1/11)
  • 10.2.2 – Performance Improvement Goal – Sub-Goal Example (withdrawn 9/1/11)
  • 10.2.3 – Performance Improvement Goal Instructions (withdrawn 9/1/11)
  • 10.2.4 – Performance Improvement Project Submission Instructions (PDF)
  • 10.2.5 – Performance Improvement Project Template (MS Word)
  • 10.2.6 – Dental Performance Improvement Project Overarching Goals (withdrawn 9/1/13)
  • 10.2.7 – MMC/CHIP Performance Improvement Project Overarching Goals (withdrawn 9/1/13)
  • 10.2.8 – PIP Progress Report Submission Instructions (PDF)
  • 10.2.9 – PIP Progress Report Template (MS Word)

Chapter 11: Member

• 11.1 – STAR+PLUS Medicaid Estate Recovery Program (PDF)
• 11.2 – STAR+PLUS ESRD Disenrollment (withdrawn 2/11/08)
• 11.3 – STAR+PLUS Ventilator Dependent Member Disenrollment (withdrawn 2/11/08)
• 11.4 – STAR+PLUS Policy for 1915c Nursing Facility Waiver Services (withdrawn 2/1/11)
• 11.5 – MMC Member Disenrollment Policy (PDF)
• 11.6 – MMC Member Disenrollment Form (MS Word)
• 11.8 – ICM Medicaid Estate Recovery Program (withdrawn 9/10/09)
• 11.9 – ICM Policy for 1915c Nursing Facility Waiver Services (withdrawn 9/10/09)

Chapter 12: Frew

• 12.1 – FWC Annual Report and Log Instructions (PDF)
• 12.2 – FWC Plan Template (withdrawn 9/1/17)
• 12.3 – FWC Annual Report Template (MS Word)
• 12.4 – MMC THSteps Report Instructions (PDF)
• 12.5 – MMC THSteps Annual Report Template (MS Word)
• 12.6 – Annual Report Refusal Tracking Log (Excel)
• 12.7 – ICM Children of Migrant Farmworkers Plan Template (withdrawn 9/10/09)
• 12.8 – ICM Children of Migrant Farmworkers Annual Report Template (withdrawn 9/10/09)
• 12.9 – MMC THSteps Annual Report Template (STAR Health) (MS Word)
• 12.10 – ICM 90 Day Report Instructions (withdrawn 4/20/09)
• 12.11 – ICM 90 Day Report Template (withdrawn 4/20/09)
• 12.12 – ICM 90 Day Refusal (withdrawn 4/20/09)
• 12.13 – MMC THSteps Quarterly Report Template (STAR and STAR+PLUS) (withdrawn 9/1/15)
• 12.14 – MMC New Member Quarterly Refusal Tracking Log (withdrawn 9/1/15)
• 12.15 – MMC THSteps Quarterly Report Template (STAR Health) (withdrawn 9/1/15)
• 12.16 – Migrant Rewards Summary Matrix (PDF)
• 12.17 – Frew Managed Care Rewards and Sanctions Default Assignment Methodology (withdrawn 2/1/16)
• 12.18 – Frew Incentives and Disincentives (PDF)
• 12.19 – Frew QMR Instructions (PDF)
• 12.20 – Frew QMR MCO Response Template (MS Word)
• 12.21 – Frew Annual Healthcare Provider Training Report Instructions (withdrawn 2/1/16)
• 12.22 – Frew Annual Healthcare Provider Training Report Template (withdrawn 2/1/16)
• 12.23 – Frew Provider Recognition Report Instructions (withdrawn 2/1/16)
• 12.24 – Frew Provider Recognition Report Template (withdrawn 2/1/16)
• 12.25 – Farmworker Child(ren) Annual Report Log (Excel)
• 12.26 – Migrant Incentive Supporting Documentation Log Instructions (withdrawn 9/1/17)
• 12.27 – FWC Plan and Annual Report Instructions for Dental Services (withdrawn 6/1/16)
• 12.28 – FWC Plan Template for Dental Services (withdrawn 6/1/16)
• 12.29 – FWC Annual Report Template for Dental Services (withdrawn 6/1/16)
• 12.30 – Migrant Incentive Process - Summary Matrix for Dental Services (withdrawn 6/1/16)
• 12.31 – Migrant Incentive Process - Support Doc Log for Dental Services (withdrawn 6/1/16)
• 12.32 – Migrant Incentive Process - Dental Services (withdrawn 6/1/16)
• 12.33 – Frew QMR Dental Plan Response Template Instructions (withdrawn 9/1/17)
• 12.34 – Frew QMR Dental Plan Response Template (withdrawn 9/1/17)
• 12.35 – Frew Annual Dental Provider Training Report Instructions (withdrawn 2/1/16)
• 12.36 – Frew Annual Dental Provider Training Report Template (withdrawn 2/1/16)
• 12.37 – Frew Dental Provider Recognition Report Instructions (withdrawn 2/1/16)
• 12.38 – Frew Dental Provider Recognition Report Template (withdrawn 2/1/16)
• 12.39 – MMC THSteps Medical Utilization Instructions (withdrawn 2/1/16)
• 12.40 – MMC THSteps Medical Utilization Report (withdrawn 2/1/16)

Chapter 13: Supplemental Payments.

• 13.1 – Supplemental Payments for Qualified Providers (PDF)

Chapter 14: CHIP Dental

• 14.1 – CHIP Dental Tier Schedule (withdrawn 3/1/12)

Chapter 15: Utilization Management

• 15.1 – Mental Health Targeted Case Management and Mental Health Rehabilitative Services (PDF)
• 15.2 – Mental Health Targeted Case Management and Mental Health Rehabilitative Services Request Form (MS Word)
• 15.3 – Mental Health Targeted Case Management and Mental Health Rehabilitative Services Training Requirements (PDF)
• 15.4 – MH Targeted CM and MH Rehab Services Request Instructions (PDF)
• 15.5 – Non-Emergency Ambulance Services Request Instruction (PDF)
• 15.6 – Prior Authorization Annual Review Guidelines and Reporting Instructions (PDF)
• 15.7 – Managed Care Utilization Review Rebuttal Process (PDF)
• 15.8 – LTSS Long-Term Services and Supports Utilization Review Performance Standards and Benchmarks (Excel)

Chapter 16: Policy Guidance

• 16.1 – Medicaid and CHIP Contract Operational Guidance (PDF)
• 16.2 – STAR Health MDCP Policy (PDF)
• 16.3 – In-Lieu-of Covered Services and Settings (PDF)
• 16.4 – Nonemergency Medical Transportation (NEMT) Services Handbook (PDF)
  • 16.4.1 – Nonemergency Medical Transportation (NEMT) Encounter to Healthcare Claim Matching Process (PDF)
    • 16.4.1.1 – Nonemergency Medical Transportation (NEMT) Encounter to Healthcare Claim Matching Root Cause Analysis Template (MS Word)
• 16.5 – Service Coordination and Assessment Requirements When Using Telecommunications (PDF)
• 16.6 – Medicaid and CHIP Health Plan Inquiry Guide (PDF)
  • 16.6.1 – Medicaid/CHIP Health Plan Inquiry Form (MS Word)
• 16.7 – Comprehensive Health Homes for Integrated Care (CHIC) (PDF)
• 16.9 – Durable Medical Equipment (DME)
• 16.10 – Non-Medical Needs Screening for Pregnant Members

Chapter 17: Reserved

Chapter 18: Record Retention Requirements (PDF)

Chapter 19: HHSC Operational Review

• 19.1 – Contractor Requirements for HHSC Operational Reviews (PDF)