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About RightCare

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Here's your go-to guide for RightCare

Filled with useful information, your member handbook helps you get the care you need. Read through to learn all about your benefits. It's pretty handy to have, especially if you don't always have Internet access. Inside you'll find:

Download RightCare Member Handbook

RightCare Member Handbook Table of Contents

About Notifications and Prior Authorizations

STAR Medicaid Terms and Definitions

If you need this book in a different format such as audio, large print, braille or in a language other than English and Spanish, call RightCare Member Services.

Call RightCare at 1-855-897-4448 to get paper copies of helpful information:

  • Member Handbook
  • Provider Directory
  • Privacy Practices
  • Members Rights & Responsibilities
  • Anything on our website

This information will be sent at no cost to you within five (5) business days.

Texas Health and Human Service - Texas STAR

Member Information

Texas Health Steps is the Medicaid health-care program for children, teens and young adults, birth through age 20. If your child's provider finds a health problem during a checkup, your provider can make sure your child gets the medical care that is necessary to help prevent problems that could make it hard for your child to learn and grow.

Need a Ride? Nonemergency Medical Transportation (NEMT) — Starting June 1, 2021, we can help you or your child get a ride, at no cost, to the doctor, hospital, dentist and drugstore.

Replacement ID Card — If you lose your RightCare STAR Medicaid ID Card, call us right away at 1-855-897-4448 to get a new one. If you don't have the card, you can still go to the doctor, clinic or hospital. You might have to wait for services while your RightCare membership is checked.

Member Rights and Responsibilities

Texas Medicaid for Children — 1-877-THSteps (847-T8377)

Notice of Privacy Practices — For information on how medical information about you may be used and disclosed and how you can get access to this information use the Notice of Privacy Practices.

New website for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) at texaswic.org

The website includes features such as online nutrition classes, recipes, and a newsletter feature that provides parents with customized information based on the child's current age for children ages 1-5. Parents can subscribe to the newsletter here for information in English and here for information in Spanish.

Join Texas WIC

HB 12 FAQ

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Provider Directory

For Additional Assistance with scheduling an appointment, finding a provider or choosing a PCP call Member Services at 1-855-897-4448.

Specialty Providers Referrals — Referrals are needed to see most RightCare specialty provider. A referral is an approval from your PCP for you to get specialty care and follow up treatment. If you receive services from a specialist without your PCP’s referral, or if the specialist is not a RightCare provider, you might be responsible for the bill. You can get some services without going to your PCP first. These include:

  • 24-hour Emergency Care (if you feel you have a true medical emergency)
  • Routine Vision Care
  • Dental Services (for children)
  • OB/GYN Care
  • Family Planning Services and Supplies
  • Behavioral (Mental) Health and Substance Abuse Services
  • Texas Health Steps

With MyBSWHealth, you can get care anytime—no matter where you are in Texas. All you need is Wi-Fi or a cell signal and a phone, computer or tablet. Want to know more? See our step-by-step guide.

Medicaid Appeals Process

You can appeal a decision if Medicaid covered services are denied based on lack of medical need.

File a Complaint

Scrubbing In

A NEW alternative to Grow Well

RightCare from Scott and White Health Plan invites you to explore Scrubbing In, weekly wellness advice for all life stages, to help keep you and your family healthy and at your best.

NOTE: Scrubbing IN offers a provider search tool that may not apply to your Medicaid coverage.

Mindoula - Behavioral Health Support

Who qualifies?

Active Scott and White Health Plan STAR members qualify based on certain conditions. Mindoula will reach out to you if you qualify.

How can Mindoula help?

Mindoula is a behavioral health management vendor that provides tech-enabled (digital) 24/7 case/care management and psychiatric support to members with behavioral health challenges and multiple medical needs.

Programs provided by Mindoula and their StrongWell Program:

  • Interpersonal Violence Reduction Program (IVRP)
  • Suicide Prevention Program (SPP)
  • SUD (Substance Use Disorder) Exposed Pregnancy (SEPP)
  • Substance Exposed Living Program (SELP)

Pharmacy & Drugs

RightCare members can access prescriptions through any pharmacy that is contracted with Navitus Health Solutions. Navitus administers prescription benefits for RightCare STAR Members. For pharmacy questions, contact Customer Service at 1-855-897-4448.

You can view your pharmacy directory using the links below:

Formulary

Pharmacy Benefit Drugs
  • RightCare uses the state mandated STAR formulary. The formulary is available on the Medicaid Drug Vendor Drug Program website.
  • The Texas STAR Formulary is available in paper form without charge. To request a copy, please call RightCare Customer Service at 1-855-897-4448.
Medical Benefit Drugs
  • For list of drugs covered under medical benefit, please refer to the Texas Health and Human Services Vendor Drug Program Formulary – Clinician-Administered Drug found here: Data Files | Vendor Drug Program

Prior Authorizations

Pharmacy Benefit Drugs

To obtain a prior authorization, providers should call Navitus at 1-877-908-6023. For a listing of clinical edits implemented by RightCare, click here. For access to RightCare's prior authorization forms, please click here.

Medical Benefit Drugs
  • For information regarding prior authorization submission for drugs obtained under the medical benefit, please refer to Authorizations

Member Forms

Complaints Process

If you have a complaint, please call us toll-free at 1-855-897-4448 to tell us about your problem.

HHSC Notifications

    • NCQA Health Plan Accredited
    • RightCare by Scott and White Health Plan has received Accreditation from the National Committee for Quality Assurance (NCQA). This means that RightCare by Scott and White Health Plan's service and clinical quality meet the basic requirements of NCQA's rigorous standards for consumer protection and quality improvement. Consumers can easily access organizations' NCQA statuses and other information on healthcare quality by visiting ncqa.org or calling NCQA Customer Support at 888-275-7585.
    • NCQA Health Equity Accredited