Claims Processing System
About...
ACS-Pharmacy is responsible for pharmacy claims processing and managing the rebate administration functions for the Vendor Drug Program.
System Information
- Please refer to the Pharmacy Provider Procedure Manual and payer specification documents for complete claim submission requirements and guidelines, including NCPDP format.
- The claim system undergoes regularly scheduled weekly maintenance between 11 p.m. Saturdays and 1 a.m. Sundays (central time). Pharmacies will be unable to submit claims during this time. Extended maintenance periods may occur and notification will be sent through the Texas Health and Human Services subscription e-mail service.
- ACS-Pharmacy maintains the weekly payment registers and the standard ASC X12N 835 Health Care Payment/Advice online for pharmacy providers.
- Vendor Drug has developed two electronic client eligibility verification methods for use by pharmacy staff. These tools can help avoid excess eligibility-related calls to Pharmacy Resolution Help Desk, and are available after hours and on weekends.
- Some claim rejections can be resolved by pharmacies without making a call to the Pharmacy Resolution Help Desk. Please review these solutions to address the most common claim reject issues.