All your forms and tools in one place

Provider Directories

• Provider Directory
• Pharmacy Directory
• Vision Care Providers (Superior/Block Vision)
• Dental Care Providers (Liberty Dental)

Extra Member Benefit Vouchers

• Asthma - Regular Refills Gift Card See online form here.
• Earn up to $170 in Gift Cards for Pregnant Members See online form here.
• Behavior or Emotional Health - Inpatient Follow-Up Gift Card See online form here.
• Texas Health Steps Checkup Gift Card See online form here.
• $20 Toward a Baby Monitor See online form here
• $50 Toward a Newborn Car Seat See online form here.
• $20 Toward a Baby Stroller See online form here.
• $50 Toward a Toddler Car Seat See online form here.
• $20 Toward a Booster Car Seat See online form here.

Member Forms

• Prescription Mail Order Form - English
• Prescription Mail Order Form - Spanish
• Authorization for Release of Information
• Authorization for Release of Information - Spanish

Member Notices

• Semi-Annual Preferred Drug List Update Texas Medicaid is updating the Medicaid preferred drug list starting January 30. Visit the Vendor Drug Program website for the changes.
• Morphine Equivalent Dose Limitations for RightCare to Decrease in January. RightCare from Scott and White Health Plan will decrease the daily morphine equivalent dose limit for people enrolled in Medicaid Managed Care on January 1, 2019. The new limit will be set at 90 and will apply to all opioid prescriptions, with exceptions for those people diagnosed with cancer or those receiving palliative or hospice care. Members can call 1-855-897-4448 for assistance.
• Antipsychotics Clinic Prior Authorization Changes Begin September 1. RightCare from Scott and White Health Plan will revise the antipsychotics clinical prior authorization for people enrolled in Managed Medicaid beginning 9/1/18. To learn more, please review the antipsychotics clinical prior authorization guide (PDF).
• Notice of Change to Covered Services - Prescribed Pediatric Extended Care Center (PPECC)