July 13, 2017

Starting this fall all prescribing providers must be enrolled by Texas Health and Human Services (HHS) for those services to be eligible for payment. This applies to pharmacy claims for people with either Medicaid fee-for-service or managed care, the Children with Special Health Care Needs (CSHCN) Services Program, and Healthy Texas Women Program. Pharmacy claims will deny if the prescribing provider identified on the claim is not enrolled with HHS by October 16.

This will also apply to Children’s Health Insurance Program pharmacy claims beginning January 1, 2018.