Log in to My Account
Go to TexMedConnect
I would like to...  Click here to access provider applications and services.
Skip to main content
Heading: Providers Texas Medicaid 
Image of provider
Texas MedicaidCSHCNFamily PlanningLong Term CareEDIMTPHealth ITTexas WHP

Find Web Parts

 Forms for Medicaid Providers

The forms on this page are all of the current forms needed by Texas Medicaid providers. The forms are grouped by type to make locating the correct form easier.

Claim Form Examples - This page has completed claim forms with sample data.

 Current Forms

PA on the Portal Click here for more information on PA on the Portal.
Topics: Information of interest to providers, including NDC and Alberto N. and past initiatives such as PACT transition and hurricanes
Provider ReenrollmentNewsDisclosure of ownership
E-Signature InstructionsTexas Women's Health Program: Click here for information

Terms and Conditions | Contact Us | Help | Employment