Pharmacy providers can use one of the following HHSC eligibility tools to verify the client’s enrollment in managed care:
- The NCPDP Eligibility Verification (E1) Transaction submitted through the pharmacy’s point-of-sale software
- The Pharmacy Eligibility Verification Portal (EVP) is a browser-based application accessible to all Medicaid-enrolled pharmacy providers
- Call the TMHP Contact Center to find enrollment status and the name of the MCO for clients enrolled in Medicaid or CHIP
Pharmacy providers should contact the client's specific MCO for its claims routing information, including Bank Information Number (BIN), Processor Control Number (PCN), and Group ID.