Managed care is a system where the overall care of a patient is overseen by a single provider or organization as a way to improve quality and control costs. The manual below defines procedures that Managed Care Organizations (MCOs) must follow in order to meet certain requirements in the HHSC managed care contracts, and to provide interpretation on contractual provisions that need clarification.

People needing accessibility assistance with these documents should contact Melissa Ramos via email at Melissa.Ramos@hhsc.state.tx.us.

Uniform Managed Care Manual

Chapter 1

Chapter 2: Texas Claims Procedures

Chapter 3: Critical Elements

Chapter 4: Marketing Policies and Procedures

Chapter 5: Deliverables, Report Formats, Due Dates

Chapter 6: Financial

Chapter 7: Management Information Systems (MIS)

Chapter 8: Provider

Chapter 9: Disease Management (DM)

Chapter 10: Contract Management Tools

Chapter 11: Member

Chapter 12: Frew

  • 12.1 - FWC Plan and Annual Report Instructions
  • 12.2 - FWC Plan Template (withdrawn 9/1/2017)
  • 12.3 - FWC Annual Report Template
  • 12.4 - MMC THSteps Report Instructions
  • 12.5 - MMC THSteps Annual Report Template
  • 12.6 - Annual Report Refusal Tracking Log
  • 12.7 - ICM Children of Migrant Farmworkers Plan Template (withdrawn 9/10/09)
  • 12.8 - ICM Children of Migrant Farmworkers Annual Report Template (withdrawn 9/10/09)
  • 12.9 - MMC THSteps Annual Report Template (STAR Health)
  • 12.10 - ICM 90 Day Report Instructions (withdrawn 4/20/09)
  • 12.11 - ICM 90 Day Report Template (withdrawn 4/20/09)
  • 12.12 - ICM 90 Day Refusal (withdrawn 4/20/09)
  • 12.13 - MMC THSteps Quarterly Report Template (STAR and STAR+PLUS) (withdrawn 9/1/15)
  • 12.14 - MMC New Member Quarterly Refusal Tracking Log (withdrawn 9/1/15)
  • 12.15 - MMC THSteps Quarterly Report Template (STAR Health) (withdrawn 9/1/15)
  • 12.16 - Migrant Rewards Summary Matrix
  • 12.17 - Frew Managed Care Rewards and Sanctions Default Assignment Methodology (withdrawn 2/1/16)
  • 12.18 - Frew Incentives and Disincentives
  • 12.19 - Frew QMR Instructions
  • 12.20 - Frew QMR MCO Response Template
  • 12.21 - Frew Annual Healthcare Provider Training Report Instructions (withdrawn 2/1/16)
  • 12.22 - Frew Annual Healthcare Provider Training Report Template (withdrawn 2/1/16)
  • 12.23 - Frew Provider Recognition Report Instructions (withdrawn 2/1/16)
  • 12.24 - Frew Provider Recognition Report Template (withdrawn 2/1/16)
  • 12.25 - Migrant Incentives Supporting Documentation
  • 12.26 - Migrant Incentive Supporting Documentation Log Instructions (withdrawn 9/1/2017)
  • 12.27 - FWC Plan and Annual Report Instructions for Dental Services (withdrawn 6/1/16)
  • 12.28 - FWC Plan Template for Dental Services (withdrawn 6/1/16)
  • 12.29 - FWC Annual Report Template for Dental Services (withdrawn 6/1/16)
  • 12.30 - Migrant Incentive Process - Summary Matrix for Dental Services (withdrawn 6/1/16)
  • 12.31 - Migrant Incentive Process - Support Doc Log for Dental Services (withdrawn 6/1/16)
  • 12.32 - Migrant Incentive Process - Dental Services (withdrawn 6/1/16)
  • 12.33 - Frew QMR Dental Plan Response Template Instructions (withdrawn 9/1/2017)
  • 12.34 - Frew QMR Dental Plan Response Template (withdrawn 9/1/2017)
  • 12.35 - Frew Annual Dental Provider Training Report Instructions (withdrawn 2/1/16)
  • 12.36 - Frew Annual Dental Provider Training Report Template (withdrawn 2/1/16)
  • 12.37 - Frew Dental Provider Recognition Report Instructions (withdrawn 2/1/16)
  • 12.38 - Frew Dental Provider Recognition Report Template (withdrawn 2/1/16)
  • 12.39 - MMC THSteps Medical Utilization Instructions (withdrawn 2/1/16)
  • 12.40 - MMC THSteps Medical Utilization Report (withdrawn 2/1/16)

Chapter 13 Supplemental Payments.

Chapter 14: CHIP Dental

  • 14.1 - CHIP Dental Tier Schedule (withdrawn 3/1/12)

Chapter 15: Utilization Management

Chapter 16 – Policy Guidance