Eligibility Verification (E1) Transaction Payer Sheet

Program Name

  • Traditional Medicaid
  • Children's Health Insurance Program (CHIP) *
  • Children with Special Health Care Needs (CSHCN) Services Program
  • Healthy Texas Women (HTW) Program
  • Kidney Health Care (KHC) Program

Transaction Code

  • National Council for Prescription Drug Programs (NCPDP) E1 - Eligibility Verification
  • Refer to the Eligibility Verification (E1) Transaction section of the Pharmacy Provider Procedure Manual for more information about the NCPDP transaction.


  • The processor edits all submitted data elements for valid format and values.
  • Provider software should support all data elements on the required segments.
  • In cases where multiple iterations of a field ("repeating fields") are allowed, the maximum number of iterations is indicated.
  • * E1 transactions submitted to HHSC for clients enrolled in CHIP will return a response identifying the name of the client's MCO. Pharmacies providers should contact the client's specific MCO for details.

Field Usage Description

  • Mandatory (M):
    • Submitted following the NCPDP Telecommunication Implementation Guide Version D.0
  • Required (R):
    • Always submitted
  • Required When (RW):
    • Submitted under circumstances explained in the Comment column
  • Optional (O):
    • Submitted at the discretion of the pharmacy provider
  • Repeating (***R***):
    • Designates a repeating field