- The Pharmacy Provider Procedure Manual defines policies and procedures for Medicaid-enrolled pharmacy providers regarding outpatient pharmacy claims, including drug benefit guidance, pharmacy prior authorization, coordination of benefits, and drug pricing and reimbursement.
Pharmacy Payer Sheets
- Pharmacy providers and their contracted software company should refer to the Pharmacy Provider Payer Sheets for specific claim processes. These documents define the required fields needed for processing a prescription claim (such as BIN number and process control number) and address certain claim-specific policies (such as for coordination of benefits or 340B claim processing). While this this information should be accessible through your pharmacy software system, pharmacy staff can refer back to these payer sheets when questions arise.
Drug Manufacturer Manual
- The Drug Manufacturer Manual provides Texas Medicaid processes for formulary additions, billing, and rebate programs.
- The Texas Medicaid Provider Procedures Manual contains information about Texas Medicaid benefits, policies, and procedures including medical, dental, and children’s services benefits.