This section identifies claim limitations for claims processed by HHSC (for traditional Medicaid, CSHCN, HTW, and KHC programs) or by the managed care organization. Pharmacy providers should contact the client's specific MCO for details.
Pharmacy Provider Procedure Manual
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- P-1. Introduction
- P-2. Contact Information
- P-3. Enrollment
- P-4. Managed Care
- P-5. System Requirements
- P-6. Eligibility
- P-7. Coordination of Benefits
- P-8. Drug Policy
- P-9. Home Health Supplies
- P-10. Vitamins and Minerals
- P-11. Mosquito Repellent
- P-12. Drug Utilization Review
- P-13. Prior Authorization
- P-14. Pricing and Reimbursement
- P-15. 340B Resources
- P-16. Payment
- P-17. Audits
- P-18. Drug Rebates
- P-19. Documents
- P-20. Forms