Eligibility Verification Tools

Pharmacies have multiple methods available to determine whether a client is eligible to receive Medicaid or CHIP pharmacy services. These tools are available 24/7 and provide immediate response.  Pharmacy staff should use these tools before contacting the HHSC Vendor Drug Program Pharmacy Resolution Help Desk about any eligibility or Managed Care Organization (MCO) enrollment issue.  To help pharmacies contact or bill the appropriate managed care organization for each client, the following tools should be used with the Medicaid/CHIP Pharmacy MCO Assistance chart.

 

Eligibility Verification Portal (EVP) [Web-based Tool]

The EVP is a web-based portal that is free for all pharmacies that are contracted with HHSC as Medicaid providers. This tool has been available since summer 2011.

 

·        Pharmacies that have not already registered for EVP should download and complete the Pharmacy Enrollment Form from ; or call ACS Pharmacy Technical Support and Interfaces Desk at 1-888-701-1713 to request a form. Register today.

·        Return the completed form either by fax (1-866-780-2185) or by e-mail (Pharmacy.MoveIT@tmhp.com). 

·        Enter client Social Security Number of client does not present their enrollment card, to get Medicaid/CHIP ID number

·        Enter Medicaid/CHIP ID number to get eligibility and MCO enrollment information.

·        Questions about access should be directed to the ACS-Pharmacy Technical Support and Interfaces Desk at 1-888-701-1713.

 

Beginning March 1, 2012, the EVP response will identify the client’s managed care plan, in addition to verifying the client’s eligibility for Medicaid or CHIP. 

 

Automated Toll-Free Voice Response System (AVRES)

Beginning March 1, 2012, pharmacists will have a new tool, the Your Texas Benefits Card Medicaid Eligibility service for pharmacists.

·        1-800-668-0650

·        Enter Medicaid ID number to verify eligibility and MCO enrollment.

 

Eligibility Verification (E1) Transaction [Point-of-Sale Tool]

The E1 is submitted from your point-of-sale system.  Pharmacy providers should contact their software company to discuss E1 submission issues, and to ensure “Additional Message Information” (Field 526-FQ) is returned for all responses.  Beginning March 1, the client’s managed care plan will be reported in the Additional Message Information field.