MCO Client Eligibility Contact

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

Refer to the MCO Search to find contact information for each MCO, and find each MCOs claims routing information, including Bank Identification Number (BIN), Processor Control Number (PCN), and Group ID.