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

If you are unable to reverse the claim, contact the Pharmacy Benefits Access Help Desk. The help desk can reverse claims through the current triennium, or the current fiscal year plus two previous fiscal years.

HHSC cannot electronically adjust claims dated outside the current triennium, and pharmacies must refund HHSC by check or money order. HHSC requires a pharmacy to submit a cover letter and claim-level information about the refund. The pharmacy must include its six-digit Vendor Drug contract ID number and 10-digit NPI on the documentation and the check or 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.