Beginning Aug. 1, 2021, the Health and Human Services Commission (HHSC) will reject Healthy Texas Women (HTW) pharmacy claims if the prescribing provider has not completed HTW certification with the Texas Medicaid & Healthcare Partnership (TMHP). Rejected claims will display National Council for Prescription Drug Programs error code 71 (Prescriber Not Covered) and a message indicating the prescriber is not HTW certified. The HHSC Pharmacy Benefit Help Access Desk cannot override this rejection.
Pharmacy staff who get this denial message should inform both the client and the prescriber that HHSC cannot process the claim until the prescriber completes certification. Pharmacy staff can provide the following resources to providers and clients:
- Prescribers can call the TMHP Contact Center at 1-800-925-9126 or use the TMHP Provider Information Management System (PIMS) to complete the certification or to check the status of their certification. For more information about using PIMS, refer to the PIMS instructions for HTW Certification and Attestation (PDF).
- Clients can call TMHP at 800‑335‑8957 for assistance in locating HTW certified prescribers.
- VDP will revise the prescriber search to identify HTW certified providers, beginning Aug. 2, 2021.
For more information about HTW provider policies, including provider enrollment and the HTW certification, refer to the “Healthy Texas Women Program Handbook” of the Texas Medicaid Provider Procedures Manual, or visit tmhp.com/programs/htw.