Pharmacy Providers
Pharmacy providers must enroll with HHSC through the Provider Enrollment and Management System (PEMS) 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.
- Refer to the Pharmacy Provider Procedure Manual
- Refer to the pharmacy payer sheets
- Download enrollment-related documents and forms
- Enroll in the Medicaid Comprehensive Care Program (CCP)
- Enroll as a durable medical equipment (DME) provider
- Review continuing education modules and other training opportunities
- Learn about the weekly payment cycle
- Access your weekly payment files,
- Review the annual payment delays
- Learn about real-time client eligibility verification options
Prescribing Providers
Prescribing providers must enroll with HHSC through the Provider Enrollment and Management System (PEMS) before providing outpatient Medicaid prescription services.
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.