Texas Medicaid/CHIP Vendor Drug Program

D.0 Format Mandatory February 1

January 13, 2012

Beginning February 1, Vendor Drug will only accept transactions in NCPDP version D.0 and will reject transactions submitted in version 5.1.
On January 25, claims will reject if the last name submitted in the “Patient Last Name” field (311-CB) does not match the last name on VDP.

Medicaid Managed Care Expansion. March 1. Are You Ready?

January 2, 2012

On March 1, 2012, people with Medicaid managed care or CHIP will get their pharmacy benefits through a managed care plan – not the Vendor Drug Program. Pharmacy providers are encouraged to learn which health plans and pharmacy benefit managers (PBMs) will be serving Medicaid and CHIP clients in their county, as well as attend training sessions provided by the health plans to learn how to submit claims, where to call for assistance, and their unique policies/procedures for Medicaid/CHIP clients. Learn more.

What We Do

The Medicaid/CHIP Vendor Drug Program processes out-patient pharmacy prescriptions for: Medicaid, Children’s Health Insurance Program (CHIP), Children with Special Health Care Needs (CSHCN) Services Program, and the Kidney Health Care (KHC) program.

How to Participate

News Highlights

Submitting the Prescriber NPI

October 14, 2011

The Pharmacy Resolution Help Desk reports an increase in rejections related to how pharmacies are submitting prescriber identifier numbers:

Prescriptions written by nurse practitioners and physician assistants must be submitted using the license number or NPI of the supervising physician.
Prescriptions written by interns and residents may be submitted using the license number or NPI of the supervising physician. They may also use the license number or NPI of their training institution as verified by the Vendor Drug Program.
If your claim rejects with error code EZ, please ensure you are submitting the correct combination of ID number and qualifier in "Prescriber ID Qualifier" (Field 466-EZ) and "Prescriber ID" (Field 411-DB). Other qualifier values are not supported and will cause the claim to reject.
If you submit your claim with the NPI but receive error code 71 or 56, please attempt to resubmit with the state license number. If your pharmacy software does not allow you to submit the state license number, please contact your software provider.
State license and NPI numbers are available.