Revised VDP Payer Sheets Now Available, For Use Beginning March 30

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The Texas Health and Human Services Commission (HHSC) selected Gainwell Technologies (Gainwell) as the pharmacy benefit administrator for the Texas Vendor Drug Program (VDP). Gainwell will continue to use the National Council for Prescription Drug Programs (NCPDP) standard D.0 telecommunication standard format for pharmacy claim transactions using a computerized point-of-sale system.

Gainwell processes all fee-for-service Medicaid, Children with Special Health Care Needs (CSHCN) Services Program, Kidney Health Care (KHC) Program, and Healthy Texas Women (HTW) Program pharmacy claims. All claim submission requirements are available in the Pharmacy Provider Procedure Manual. An updated manual will be available on the new VDP Provider Portal on March 30, 2024.

You have 60 calendar days from this notice to make necessary changes or system modifications to accommodate the changes made in the VDP payer sheets. Pharmacies risk denied claims by not completing these changes by March 30, 2024.

The NCPDP Telecommunications Guide (PDF) is a publication of the standards for NCPDP transactions. All submitters of NCPDP transactions must utilize these standards following a prescribed format.

The VDP payer sheets complement accepted values of the NCPDP Telecommunications Guide. Payer sheets provide payer-specific business rules and requirements for claims processing. You must refer this information to your software and switch vendors to support the required changes in your point-of-sale billing system.

Refer to the System Transition Resources for more information about this change. You can also register with the HHSC email notification service to review emails from VDP about the change.