Pharmacy Payer Sheets

Claim Billing Transaction (B1)

• Programs: Medicaid, CSHCN, HTW
  • Payer specifications (PDF) (effective Sept. 21, 2020)
• Programs: KHC
  • Payer specifications (PDF) (effective April 1, 2021)

Claim Billing Reversal Transaction (B2)

• Programs: Medicaid, CSHCN, HTW, KHC
  • Payer specifications (PDF) (effective Sept. 21, 2020)

Eligibility Verification (E1)

• Eligibility Verification (E1) Transaction Payer Sheet
  • Eligibility Request
  • Accepted Response
  • Rejected Response