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About Notifications and Prior Authorizations

Some services require notifications or prior authorization. All out-of-network physician, hospital, or ancillary service requests require prior authorization.

Notification and Prior Authorization Lists

Medical and Behavioral Services

Medical Services Prior Authorization List Effective 11/01/2019

RightCare Authorization Request Form & Instructions

Behavioral Health Referral Authorization Form and Instructions

Pharmacy Notifications and Prior Authorizations

The Texas Medicaid Formulary and Preferred Drug List (PDL) are maintained by the Texas HHSC Vendor Drug Program (VDP). RightCare from Scott and White Health Plan administers the prior authorization criteria developed by Texas HHSC VDP

For a listing of clinical edits implemented by RightCare, please visit the Navitus Health Solutions website. Additional information regarding formularies, P&T committee updates, and access to prior authorization forms can also be found here.

View the Preferred Drug List (PDL). This list is created and maintained by the Texas Vendor Drug Program (VDP).