Form 1052 Public Provider Choice Request - Texas

What Is Form 1052?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 1052?A: Form 1052 is a Public Provider Choice Request form in Texas.

Q: What is the purpose of Form 1052?A: Form 1052 is used to request a change in the managed care organization (MCO) for Medicaid services in Texas.

Q: Who can use Form 1052?A: Form 1052 can be used by individuals who are currently enrolled in a Medicaid managed care plan in Texas.

Q: What information is required on Form 1052?A: Form 1052 requires information such as the applicant's name, Medicaid ID, current MCO name, and the requested new MCO name.

Q: Is there a deadline for submitting Form 1052?A: There is no specific deadline mentioned on the form, but it is recommended to submit the form as soon as possible.

Q: What happens after submitting Form 1052?A: After submitting Form 1052, the Texas Health and Human Services Commission will review the request and notify the applicant of the outcome.

Q: Can I appeal if my Form 1052 request is denied?A: Yes, if your Form 1052 request is denied, you have the right to appeal the decision.