Pharmacy providers must enroll with Texas Medicaid before providing outpatient prescription services and participating in any managed care network. MCOs must allow any pharmacy provider willing to accept the terms and conditions of their contract to enroll in their network. To participate in Medicaid or CHIP managed care networks, the pharmacy must contact the MCO.
Prescribing providers must enroll with Texas Medicaid before providing outpatient Medicaid prescription services using the Provider Enrollment and Management System (PEMS).
Prescribing physicians do not enroll with VDP, but demographic data about prescribers are received monthly from various state licensing bodies. The information is loaded into the VDP claims system and used in the adjudication process. VDP loads the following provider types:
- Medical doctors (MD)
- Doctor of Dental Surgery (DDS)
- Doctor of Osteopathic Medicine (DO)
- Doctor of Podiatry (DP & DPM)
- Advanced Practice Registered Nurses (APRN)
- Prescribing Pharmacist (PH)
- Physician Assistants (PA)
- Therapeutic Optometrist & Glaucoma Specialist (OD & OGD)
If the prescribing provider's National Provider Identifier (NPI) is not on file with VDP then users may query the NPI Registry. Pharmacy staff can contact us to have the NPI added and allow claims to process.