P-5.4.Claim Submission

Pharmacy providers must submit correct information on all prescription claims, including National Provider Identification (NPI) numbers for pharmacy and prescriber, National Drug Code (NDC), drug quantity, and days supply. Inaccurate information runs the risk of an audit exception and causes erroneous data on reports. Noncompliant pharmacies may be referred to the HHSC Inspector General (IG). Refer to the information below for fields and values used in HHSC claims processing.

Field Description
Bank Information Number (BIN)

610084

Processor Control Number (PCN)

DRTXPROD: For Medicaid, CSHCN, and HTW (and CHIP*)

DRTXPRODKH: For KHC

Group ID

MEDICAID

CHIP *

KHC

CSHCN

Cardholder ID

Program-specific ID Number

Service Provider ID

10-digit Pharmacy NPI

Prescriber ID

10-digit Prescriber NPI

Product/Service ID 11-digit NDC

* Refer to the Claims Billing (B1) Transaction for transaction responses.