Welcome Texas Providers 

Provider Notification

• Participating Provider Laboratory and
  Pathology Protocol - Aug 2016

Optum Network Manual

• Network Manual

Clinical Criteria

• Standard Clinical Criteria

Best Practice Guidelines

• BP Guidelines

Coordination of Care (COC)

• COC Flyer
• COC Checklist

Taxonomy Bulletins, Alerts, and Manuals

• ACA Taxonomy Requirements effective 9/1/18 – Provider Alert
  
• Provider Alert - Billing Care Provider Taxonomy Required on Claims
  
• SMART Edits for Taxonomy effective 8/16/18
  

Provider Contract Provisions and Compliance Requirements

• Coming soon

Additional information and forms are available, including psych/neuropsych testing guidelines, credentialing plans, and Disability Solutions Manual, on the Provider Express Guidelines/Policies & Manuals and Optum Forms pages.

Texas Medicaid-Specific Resources

Clinicians and Facilities who see Texas Star or Texas Star Plus Membership (in the counties of Brazoria, Ft. Bend, Galveston, Harris, Montgomery and Waller) should refer to the following manuals for information specific to that membership:

• STAR+PLUS Optum Clinician Manual
• STAR Optum Clinician Manual
• Texas Medicaid Prior Authorization Form  Fax number: 844-280-1168
• Community Based Service Deviation Request Online Submission Training
• Community Based Service Deviation Request Form

Texas Medicare-Specific Resources

• Kelsey Care Advantage
• TXSTAR COB when Medicare is Primary bulletin
• Memorial Hermann transitions to Apex Health

Texas Commercial-Specific Resources

• Texas Gold Carding Frequently Asked Questions