Refer to the Clinician-administered Drug section for CAD claim submission information.

Email

vdp-cad@hhsc.state.tx.us 

Refer to the Eligibility Verification Portal to learn about real-time eligibility verification. Refer to the Eligibility Verification (E1) Transaction to use these tools to identify Medicaid or CHIP clients.

Telephone

888-701-1713 - Conduent Technical Support and Interfaces Desk

Monday to Friday, 8:00 a.m. to 5:30 p.m. (central)

Fax

866-780-2185

Website

txpcra.pharmacy.services.conduent.com/PBMPortal/login.jsp

Refer to the Payment File Portal to download weekly payment files.

Telephone

888-701-1713 - Conduent Technical Support and Interfaces Desk

Monday-Friday, 8:00 a.m. to 5:30 p.m. (central)

Fax

866-780-2185

Website

moveit.services.conduent.com

Have your pharmacy’s 10-digit National Provider Identifier (NPI) number and the appropriate cardholder ID number ready to expedite your call.

Telephone

800-435-4165 - Pharmacy Benefits Access Help Desk

A pharmacy with a current license or registration with the Texas State Board of Pharmacy or is licensed under the laws of another state, and is free from any pharmacy board restriction, may apply to become a Texas Medicaid pharmacy provider. Pharmacies must enroll before providing outpatient Medicaid prescription services.

Telephone

800-925-9126, Option 4 - TMHP Contact Center

Email

provider.relations@tmhp.com

Website

tmhp.com/topics/provider-enrollment/provider-enrollment-help

The site includes video tutorials, training modules, guides and FAQ documents.

Mailing Address

Accounts Receivable Tracking System (BH-1470)

Texas Health and Human Services

Attention: VDP Refunds

701 W. 51st St., Austin, Texas 78751

Physical Address

Accounts Receivable Tracking System (BH-1470)

Texas Health and Human Services

Attention: VDP Refunds

P. O. Box 149055, Austin, Texas 78714

The call center verifies requests within three business days and responds to pharmacy providers with updates to allow for claim processing.

Telephone

866-389-5594 - Texas Third-party Call Center

Monday-Friday, 8:30 a.m. to 5:15 p.m. (central)

Pharmacy providers can use one of the following HHSC eligibility tools to verify the client’s enrollment in managed care:

• The NCPDP Eligibility Verification (E1) Transaction submitted through the pharmacy’s point-of-sale software
• The Pharmacy Eligibility Verification Portal (EVP) is a browser-based application accessible to all Medicaid-enrolled pharmacy providers
• Call the TMHP Contact Center to find enrollment status and the name of the MCO for clients enrolled in Medicaid or CHIP

Refer to the MCO Search to find contact information for each MCO, and find each MCOs claims routing information, including Bank Identification Number (BIN), Processor Control Number (PCN), and Group ID.

Refer to the Managed Care Complaints section to learn about the complaint process.

Mailing Address

Managed Care Compliance and Operations (MCCO) (H-320)

Texas Health and Human Services

4900 North Lamar Blvd., Austin, TX 78751

Email

hpm_complaints@hhsc.state.tx.us

Website

HHSC

hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/submit-a-complaint

Texas HHS Ombudsman

hhsportal.hhs.state.tx.us/heartwebextr/hhscOmd

Refer to the MCO Search to find contact information for each MCO.

Refer to the MCO Search to find contact information for each MCO and inquire about a new, pending, or existing contract with each MCO and pharmacy benefits manager (PBM).

Refer to the MCO Search to find contact information for each MCO, and links to each MCO’s clinical prior authorization website.

Refer to the Pharmacy Clinical Prior Authorization Assistance Chart for a list of the clinical prior authorizations each MCO uses and how those authorizations relate to those used for processing fee-for-service Medicaid claims.

Refer to the MCO Search to find contact information for each MCO.

Mailing Address

HHSC Inspector General

Texas Health and Human Services

P.O. Box 85200, Austin, TX 78708-5200

Physical Address

HHSC Inspector General

Texas Health and Human Services

11501 Burnet Road, Building 902, Austin, TX 78758

Telephone

800-436-6184 - IG Integrity Line

Website

oig.hhs.texas.gov

Telephone

800-568-2413 - CSHCN Services Program Automated Inquiry System (AIS)

24-hour access

Website

txpcra.pharmacy.services.conduent.com/PBMPortal/login.jsp

Refer to the Eligibility Verification Portal section to learn more about real-time eligibility verification. Refer to the Eligibility Verification (E1) Transaction to use these tools to identify CSHCN Services Program clients.

Telephone

800-435-4165 - Pharmacy Benefits Access Help Desk

Monday-Friday, 8:30 a.m. to 5:15 p.m. (central)

This number is only for pharmacy providers. Have your pharmacy’s 10-digit National Provider Identifier (NPI) number and the appropriate cardholder ID number ready to expedite your call.

Mailing Address

CSHCN Services Program, MC 1938

Attention: CSHCN Prior Authorization

P.O. Box 149030, Austin, TX 78714-9947

For prior authorization appeals:
Attention: CSHCN PA Administrative Review

Fax

512-776-7238

Prescribing providers must send letters of medical necessity on office letterhead.

Telephone

800-435-4165 - Pharmacy Benefits Access Help Desk

Monday-Friday, 8:30 a.m. to 5:15 p.m. (central)

This number is only for pharmacy providers. Have your pharmacy’s 10-digit National Provider Identifier (NPI) number and the appropriate cardholder ID number ready to expedite your call.

Telephone

(877) 835-7750 - COVID-19 Vaccine Provider Hotline
8 a.m. to 5 p.m., Monday through Friday (central)

Email

• COVID19VacEnroll@dshs.texas.gov

Website

• DSHS Immunization Program Portal
  • enrolltexasiz.dshs.texas.gov/CRC/Site/emrlogin.asp
• Vaccination Provider Enrollment
  • enrolltexasiz.dshs.texas.gov/CRC/Site/eregister1.asp

Telephone

800-335-8957 - Medicaid Client Helpline

Monday-Friday, 7:00 a.m. to 7:00 p.m. (central)

Provider Enrollment and Management System (PEMS)

tmhp.com/topics/provider-enrollment/pems/start-application

Provider Enrollment

tmhp.com/topics/provider-enrollment

Fee Schedule

public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx

Learning Management System (LMS)

• learn.tmhp.com
• LMS Registration and Navigation Job Aid for Providers

Manual, Texas Medicaid Provider Procedures (TMPPM)

tmhp.com/resources/provider-manuals/tmppm

News

tmhp.com/news

Provider Education and Training

tmhp.com/resources/provider-education-and-training

Online Provider Lookup

opl.tmhp.com

Provider Support Services

tmhp.com/resources/provider-support-services

Website

medifacd.mckesson.com/e1/

The Medicare Eligibility Verification Transaction allows pharmacies to submit necessary demographic information on a beneficiary to receive the required information for proper billing to the person’s Part D Plan.

Telephone

800-783-1307

Website

cms.gov/Medicare/Eligibility-and-Enrollment/LowIncSubMedicarePresCov/MedicareLimitedIncomeNET

For Medicaid fee-for-service pricing inquiries, contact CMS. HHSC no longer uses the maximum allowable cost (MAC).

Telephone

855-457-5264

Fax

844-860-0236

Pharmacy providers are encouraged to fax a copy of the manufacturer's invoice

Email

info@mslcrps.com

Website

medicaid.gov/medicaid/prescription-drugs/retail-price-survey/

Pharmacy providers should use the NADAC Request for Medicaid Reimbursement Review (PDF) to submit NADAC pricing inquiries. You must complete all fields for proper submission of this form. Do not include personal health information on your submitted form or invoice.

National Plan and Provider Enumeration System (NPPES)

• National Provider Identifier (NPI) Registration
  • nppes.cms.hhs.gov
• NPI Search
  • npiregistry.cms.hhs.gov

Texas Pharmacy Association: Instructions for Pharmacists to Apply for a NPI (PDF) (Dec. 2020)