Pharmacy providers, and their contracted software company, should refer to the Texas Pharmacy Provider Payer Sheets for specific claim processes. These documents define the required fields needed for processing a prescription claim (such as BIN number and process control number) and address certain claim-specific policies (such as for coordination of benefits or 340B claim processing). While this this information should be accessible through your pharmacy software system, pharmacy staff can refer back to these payer sheets when questions arise.
Billing Transaction (B1)
- Billing Request (PDF)
- for Medicaid, Children with Special Health Care Needs (CSHCN) Services Program, and Healthy Texas Women (HTW) Program
- Billing Request (PDF)
- for Kidney Health Care program
- Paid Response (PDF)
- Rejected Response (PDF)
Reversal Transaction (B2)
- Reversal Request (PDF)
- for all programs
- Accepted Response (PDF)
- Rejected Response (PDF)
Eligibility Verification Transaction (E1)
- Eligibility Request (PDF)
- for all programs
- Accepted Response (PDF)
- Rejected Response (PDF)