Claim Processing

This applies to drugs that are non-preferred on the preferred drug list and/or because they are subject to clinical prior authorization. Pharmacies will be paid in full for 72-hour emergency prescription claims.

To learn what is required to submit a 72-hour emergency claims, pharmacy staff should refer to the Pharmacy Provider Procedure Manual. A 72-hour emergency prescription claim can be used for people enrolled in either Traditional Medicaid or Medicaid managed care:

  • Authorization for Traditional Medicaid claims should be directed to the Texas Prior Authorization Call Center.
  • Pharmacies submitting claims for people enrolled in Medicaid managed care should refer the prescribing provider to that person's health plan’s prior authorization call center.

Pharmacy Education

We encourage pharmacy staff to post these instructions (PDF) in your pharmacy for reference and to reproduce this information for staff education.