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

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  • 14.1 - CHIP Dental Tier Schedule (withdrawn 3/1/12)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