Revised Pharmacy Payer Specification Manuals Now Available

VDP revised the pharmacy payer specification manuals to address the following:

• Added value of “9” in field 461-EU
• Added 462-EV “*When Disaster occurs, number and details will be issued” for NCPDP Claim Billing (B1) Transaction

VDP updated the following manuals with this change:

• Traditional Medicaid and Healthy Texas Women (HTW) Program
• Children with Special Health Care Needs (CSHCN) Services Program
• Kidney Health Care (KHC) Program

These manuals include program-specific rules and requirements for claims processing. We recommend you share these manuals with your software and switch vendors to ensure they have the latest version. These and other manuals are available on the VDP Provider Portal.

If you have questions about pharmacy claims processing for the programs above, call the Texas Medicaid Pharmacy and Technical Call Center  at 800-435-4165, Monday to Friday, from 7 a.m. to 7 p.m. Central Time.