Methods of Verification
A client’s eligibility status may change from month to month if financial and household circumstances change. Pharmacies have multiple methods available 24/7 to determine whether a client is eligible to receive pharmacy services through the Vendor Drug Program. Pharmacy staff should utilize these tools before contacting the Vendor Drug Pharmacy Resolution Help Desk about any eligibility or managed care enrollment issue.
Real Time Eligibility Verification
Pharmacy providers may choose to process a real-time eligibility inquiry by using either the NCPDP Eligibility Verification (E1) Transaction or Vendor Drug Eligibility Verification Portal (EVP). The E1 transaction is submitted through the pharmacy’s point-of-sale system. The Eligibility Verification Portal (EVP)is a browser-based application that is free for all contracted pharmacy providers. Pharmacy staff must complete the Pharmacy Enrollment Form to register and return the completed form either by fax (1-866-780-2185) or by e-mail (Pharmacy.MoveIT@tmhp.com). Questions about access should be directed to the ACS-Pharmacy Technical Support/Interfaces Desk at 1-888-701-1713. Please contact your software company to ensure “Additional Message Information” (Field 526-FQ) is returned for all E1 transaction responses, and refer to the Vendor Drug payer specification sheets for an explanation of the expanded messages on all real-time inquiries. These tools are also available after hours and on weekends.
Beginning March 1, 2012, real-time responses will identify the client’s managed care plan in addition to verifying the client’s eligibility for Medicaid or CHIP.
Your Texas Benefits Medicaid Card
The Your Texas Benefits Medicaid card is what Medicaid clients should present when visiting a doctor or dentist office, a clinic, or pharmacy for Medicaid services. HHSC no longer produces or distributes the monthly paper Medicaid Identification Form (Form H3087). While prescribers may verify Medicaid eligibility and clients’ medical or dental plan online at YourTexasBenefitsCard.com, pharmacists and other pharmacy staff should use one of the Vendor Drug real-time eligibility verification tools to obtain out-patient pharmacy eligibility and prescription benefits for clients. More information about the card is available for providers at.
Your Texas Pharmacy Benefits Medicaid Help Line
Beginning March 1, 2012, pharmacists can call toll-free 1-800-668-0650 to find enrollment status and the name of the Medicaid client’s managed care plan. Please have the client’s cardholder ID and date of birth ready to expedite your call.
Temporary Medicaid Eligibility Verification
Medicaid clients may present the Temporary Medicaid Eligibility Verification form (Form 1027-A) as evidence of Medicaid eligibility. While this form might not have a Medicaid number, it can be relied upon as proof of Medicaid eligibility until the family receives the Your Texas Benefits Medicaid card. Vendor Drug encourages pharmacies to verify the drug is on our formulary, fill the prescription(s), and then submit the claim(s) to Medicaid once the cardholder ID number is assigned.