P-16.6. Refunds

Pharmacies with incorrectly billed claims resulting in the pharmacy owing HHSC a refund should adjust the claim within 90 days of the original service date. Pharmacy staff should first attempt to reverse the claim. Pharmacies have 720 days from the date of service to reverse the claim online.  

If pharmacy staff are unable to reverse the claim, then they should contact the Pharmacy Benefits Access Help Desk.  Help desk staff can reverse claims through the current triennium, or the current fiscal year plus two previous fiscal years.

Claims 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 and 10-digit NPI must be displayed on both the documentation and the check/money order to expedite the refund.

Refer to the Pharmacy Refunds section of the Contact Information chapter for instruction on how to submit refunds to HHSC.