The Medicaid/CHIP Vendor Drug Pharmacy Resolution Help Desk is continuing to experience system issues that began early Monday, May 3. As a result of these issues, calls from pharmacy providers are taking much longer to complete, and callers may get a busy signal.
 
HHSC is working to resolve the issue as quickly as possible. In the meantime, here are some reminders about inquiries that pharmacies can complete without having to call the Help Desk.

Eligibility Verification:  Vendor Drug encourages pharmacy providers to use their point-of-sale system to submit an Eligibility Verification Transaction (NCPDP E1) to check eligibility status. If you do not know an individual's Cardholder ID, you can submit the individual's Social Security number, preceded by an 'S' (e.g., S123456798), to receive the client's Cardholder ID on the returned response. When you submit the Cardholder ID you will receive the following information:

• The client's most current or last effective Medicaid eligibility period (pertaining to the date submitted).
• The client's prescription limitations, if any.
• Whether the client had periods of prior eligibility.
• Whether or not the client is enrolled in a secondary program, such as CSHCN.
• Whether the client has Medicare coverage.
  

Payer sheets for the E1 transaction are available in the Vendor Drug Procedure Manual. Providers should contact their software vendors to discuss specific E1 submission questions.

NDC Inquiry: If you have a claim reject with the message, "NDC Not Covered" and you need to determine what NDCs are covered so that you can order the appropriate product, you can find this information on the Vendor Drug website. Select the "Product Search" link from the Vendor Drug homepage, enter your query information by NDC or drug name, and select the appropriate product from the list that is returned. The product details will provide an effective date and end date (if applicable) for each program (Medicaid, CHIP, CSHCN or KHC).

PA Inquiry: If you are submitting a claim that requires a Prior Authorization (PA), the Prescriber will need to request the PA from the PA Texas Call Center at 1-877-PA-TEXAS
(1-877-728-3927). Vendor Drug staff cannot remove the requirement for a PA.

If you have any questions or problems e-mail support@govdelivery.com for assistance.

Stay tuned!

Richard E. Beck, RPh
Executive Director