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
Read our complete list of medical services needing either notifications or prior authorizations. For questions about general medical notification and prior authorization, call RightCare Medical Management at 1-855-691-7947.
Medical Services Prior Authorization List Effective 12/01/2018
Medical Services Prior Authorization List Effective 06/01/2019
Read our complete list of notifications and prior authorizations for behavioral services. For questions about behavioral health notification and prior authorization, contact RightCare Behavioral Health Management at 1-855-395-9652.
Behavioral Health Services Prior Authorization List Effective 10/01/2018 Behavioral Health Prior Authorization
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).