September 15, 2017

VDP has revised the instructions for pharmacy provider enrollment as a result of Hurricane Harvey and associated flooding.  All pharmacies utilizing the VDP Hurricane Harvey Temporary Pharmacy Agreement form, regardless of location, will be unable to provide services after December 31, 2017.  Pharmacies that want to continue as a Texas Medicaid pharmacy provider will be required to undergo the regular Texas Medicaid enrollment process and have an executed provider agreement in place prior to December 31.

Pharmacy Providers (enrolled with Medicare or another State Medicaid Agency)

Providing services to people enrolled in Texas Medicaid (or other programs) from the disaster designated state:

Eligibility Verification Methods

Pharmacies will submit claims online using the NCPDP D.0 standard.  Please refer to the VDP payer sheets for claim specifications.

Pharmacy staff who are unsure which MCO a Medicaid- or CHIP-eligible person is enrolled with can use one of the two VDP real-time eligibility verification tools for clarification:

  • The NCPDP Eligibility Verification (E1) Transaction submitted through the pharmacy’s point-of-sale system.
  • The Pharmacy Eligibility Verification Portal (EVP) is a browser-based application that is free for all pharmacy providers enrolled with VDP.

If pharmacy staff does not know the person’s Cardholder ID, they can submit the person’s social security number preceded by an S (e.g., “S123456798”) to receive the person’s Cardholder ID on the returned response. When pharmacy staff submit the Cardholder ID they receive the following information:

  • The most current or last effective eligibility period (pertaining to the date submitted).
  • The client’s prescription limitations, if any.
  • Whether or not the client had periods of prior eligibility.
  • Whether or not the recipient is enrolled in a secondary program (such as CSHCN).

Please refer to the payer sheets for the E1 transaction and EVP accepted responses.  If you have questions about how to submit an E1 transaction from your store, please contact your software provider.

Pharmacy Providers (not enrolled in Medicare or another State Medicaid Agency)

Providing services to people enrolled in Texas Medicaid (or other programs) from the disaster designated state:

  • Documents:
  • Items waived
    • Application fee
    • Criminal background checks associated with Fingerprint-Based Criminal Background checks
    • Site visits

An executed agreement authorizes the pharmacy to submit claims for people enrolled in fee for service and allows the pharmacy to contract with managed care organization. Please refer to the MCO Pharmacy MCO Enrollment Chart (PDF) for enrollment information.