Non-pharmacy Enrollment
Pharmacy providers performing medical services must enroll with Texas Medicaid for reimbursement for Title XIX (Medicaid) benefits. Refer to TMHP Provider Enrollment for an application. Refer to TMHP Provider Support Services to find contact information for TMHP provider relations representatives in your area.
Comprehensive Care Program Enrollment
The Medicaid Comprehensive Care Program (CCP) can cover medically necessary drugs and supplies not available through VDP for clients from birth through 20 years. Pharmacies not enrolled with CCP should direct the client to call TMHP to locate a CCP provider. CCP providers submit claims to TMHP for medically necessary drugs, equipment, or supplies not covered by VDP, including over-the-counter drugs, nutritional products, and disposable or expendable medical supplies commonly found in pharmacies.
Pharmacies must complete an application at tmhp.com. Contact the TMHP Contact Center or email TMHP Provider Relations to request assistance from the local TMHP provider relations representative in your area. Refer to the TMHP Contact Center section for contact information.
All CCP services require prior authorization. The Texas Medicaid Provider Procedures Manual (TMPPM) includes prior authorization requirements for services through CCP. Refer to section 2.1.4 of the Children's Services Handbook of the Texas Medicaid Provider Procedures Manual (tmhp.com/resources/provider-manuals/tmppm). Pharmacies submit prior authorizations using CCP Prior Authorization Request Form (TMHP Form F00012).
Refer to the Enrollment Forms for this and other enrollment forms.
Durable Medical Equipment Provider Enrollment
Durable medical equipment (DME) is equipment or appliances manufactured to withstand repeated use; ordered by a physician for use in a client’s home; and required to correct or ameliorate a client's disability, condition, or illness. DME includes vitamin and mineral products. DME is not typically available as a pharmacy benefit.
Certain supplies and select vitamin and mineral products are a covered pharmacy benefit of the following programs:
- Medicaid
- CHIP
- CSHCN Services Program
- KHC Program
A pharmacy must enroll as a DME provider to provide the full array of durable medical equipment and supplies. Pharmacies must complete an application at tmhp.com. Contact the TMHP Contact Center or e-mail TMHP Provider Relations to request assistance from the local TMHP provider relations representative in your area. Contact the TMHP Contact Center for assistance.
All claims for DME items require a completed Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form (TMHP Form F00030). Refer to the Enrollment Forms for this form.