Texas Provider Resource Library

• ADA Claim Form
• Clinical Guidelines for Prescribing Fluoride Supplements for Caries Prevention
• Electronic Fund Transfer (EFT) Form
• Grievance Form   -   Spanish Version
• Informed Consent for Alternative Treatment Form - English
• Informed Consent for Alternative Treatment Form - Chinese
• Informed Consent for Alternative Treatment Form - Spanish
• Justification of Need For Prosthodontics
• National Provider Reference Guide
• Online Provider Portal User Guide
• Opioid Risk Tool
• Specialty Care Referral Form

Texas Contracting & Credentialing Documents - Complete Packet

• Texas Contracting Packet (all documents) – Medicare
• Texas Contracting Packet (all documents ) – Medicaid
• Texas Contracting Packet (all documents) – All Lines of Business

Texas Contracting & Credentialing - Individual Documents

• Provider Check List
• Texas Provider Agreement
• Medicare Addendum
• Medicaid Addendum
• Facility Application
• Provider Authorized Signatory Form
• Provider Compliance Attestation
• W9
• Texas State Mandated Credentialing Application

• ADA Claim Form
• Clinical Guidelines for Prescribing Fluoride Supplements for Caries Prevention
• Electronic Fund Transfer (EFT) Form
• Grievance Form   -   Spanish Version
• Informed Consent for Alternative Treatment Form - English
• Informed Consent for Alternative Treatment Form - Chinese
• Informed Consent for Alternative Treatment Form - Spanish
• National Provider Reference Guide
• Online Provider Portal User Guide
• Opioid Risk Tool
• Orientation Medicare Advantage email