Texas Medicaid/CHIP  Vendor Drug Program

Pharmacy Payment

All payable Medicaid, Children’s Health Insurance Program (CHIP), Kidney Health Care (KHC), and Children with Special Health Care Needs (CSHCN) Services Program claims will be processed and paid weekly. The weekly payment cycle begins at 12:00 a.m. on Friday and ends at 11:59 p.m. the following Thursday. Pharmacy payments are generally issued to providers’ financial institutions Monday night and are posted to providers’ accounts according to their financial institution's schedule (usually within 72 hours). Federal and state holidays may impact payment date (see list).

Payments for CHIP, KHC and/or CSHCN claims will follow the same schedule as Medicaid, but will appear on separate payment remittance advices. A separate warrant or direct deposit will be made for each program area (Medicaid, CHIP, KHC, and CSHCN).

Obtaining your Remittance Advice

Electronic remittance advices may be downloaded weekly from First Health Services Corporation by pharmacies or their designated third party agency. To enroll in this service, providers should contact First Health Provider Enrollment at 804-965-7619.

State-to-Vendor Payment Information

Pharmacies can use their 11-digit Texas Identification Number (TIN) to access the state Comptroller's website to obtain their state-to-vendor payment information. Refer to the website's "Instructions for Accessing Payment Information" section to learn about your 11-digit TIN.

• https://fmx.cpa.state.tx.us/fm/payment/index.php

For agency code:

• Use 529 (Health and Human Services Commission) for Medicaid and CHIP claims.
• Use 537 (Department of State Health Services) for CSHCN and KHC claims.

Payment Delays

There will be a one-day delay in payments to pharmacy providers in 2010 for Medicaid and the Children’s Health Insurance program because of the following federal holidays:

• Martin Luther King, Jr. Day (Monday, January 18, 2010)
  • Claims submitted January 8-14 will have a payment date of January 19, with deposits available January 21.
• Presidents Day (Monday, February 15, 2010)
  • Claims submitted February 5-11 will have a payment date of February 16, with deposits available February 18.
• Memorial Day (Monday, May 31, 2010)
  • Claims submitted May 21-27 will have a payment date of June 1, with deposits available June 3.
• Labor Day (Monday, September 06, 2010)
  • Claims submitted August 27-September 2 will have a payment date of September 7, with deposits available September 9.

A notice of these known delays, and any other unscheduled delays, will be sent through the Texas Health and Human Services subscription e-mail service.

Direct Deposit

Pharmacies that wish to receive their weekly Medicaid, CHIP, KHC, and CSHCN payment by direct deposit can complete the Texas Comptroller of Public Accounts Form 74-176 (Vendor Direct Deposit Authorization).

Form 74-176 is also used to change bank information (i.e. financial institution, account number, cancellation of account, etc.). An account change will result in the pharmacy receiving paper checks (warrants) while the process is being completed.

Completed forms should be faxed to the Medicaid/CHIP Contract Management unit at
512-491-1974.

To learn more about direct deposit, please visit the Comptroller of Public Accounts website.

Pharmacy Refunds

Claims that are billed incorrectly, resulting in the provider owing Vendor Drug a refund, should be adjusted or recouped within 90 days of the original date of service.  If it is necessary to issue a refund to Vendor Drug, the pharmacy provider should first attempt to reverse the claim themselves or contact the Pharmacy Resolution Help Desk to determine if the claim(s) can be adjusted electronically.  Pharmacies have 720 days from the date of service to reverse the claim online.  The Pharmacy Resolution Help Desk can reverse claim(s) online through the current triennium (current fiscal year plus two previous fiscal years).

Claims that are outside the current triennium cannot be adjusted electronically and must be refunded to the state by check or money order.A cover letter including individual claim-level detail is required with the refund. The pharmacy's six-digit Vendor Drug contract ID number must be displayed on both the documentation and the check/money order to expedite the refund.

Regular Mail:
Health and Human Services Commission
Attn: ARTS, BH-1470
P. O. Box 149055
Austin, Texas 78714

Overnight Mail:
Health and Human Services Commission
Attn: ARTS, BH-1470
4900 N. Lamar Blvd.
Austin, Texas 78751