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New Radiology Prior Authorization Form Now Available

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

As previously announced, effective April 1, 2024, all radiology prior authorization requests for Texas Medicaid fee-for-service clients must be submitted directly to the Texas Medicaid & Healthcare Partnership (TMHP).

Click here to download the TMHP Radiology Prior Authorization Request Form.

Providers can submit completed forms to TMHP by fax or mail at:

Fax: 833-912-1129


Texas Medicaid & Healthcare Partnership

Radiology Prior Authorization

12365-A Riata Trace Parkway

Austin, TX 78727

Note: Online and telephone submissions are not currently available for radiology prior authorization requests.

For more information, call the TMHP Contact Center at 800-925-9126.