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 01/01/2020
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).