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Children’s Health Insurance Program Eligibility

Pharmacy claims for CHIP clients are processed by the MCO. In addition, there is a co-payment amount required for the majority of CHIP clients. Pharmacy providers should contact the client's specific MCO for details.

Claims Billing (B1) Transactions submitted to HHSC for CHIP clients will reject and include a message including the name of the client's MCO. Refer to the Claims Billing (B1) Transaction payer sheets for specific transaction, segment, and field requirements.

Eligibility Verification (E1) Transactions submitted to HHSC for CHIP clients will only return the name of the MCO. Refer to the Eligibility Verification (E1) Transaction for specific transaction, segment, field requirements, and response messages.