Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
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The Vendor Drug Program (VDP) Pharmacy Claims Billing Request is the only acceptable method to submit paper claims to VDP. Paper submission is only allowed for certain state-approved situations as defined in the Pharmacy Provider Procedure Manual. All other paper forms, and Pharmacy Claims Billing Requests submitted for unapproved reasons, are not accepted and will be returned with no action taken. The form is kept for five years after the end of the federal fiscal year in which the pharmacy provider submits the form.
Pharmacy staff should complete the form in its entirety, as applicable. Form fields should be completed using NCPDP standard values when applicable. Refer to the values in the NCPDP B1 Transaction Billing Request payer sheet. The “Submission Explanation” field is required and identifies why the form is being submitted.
Mail: Texas Health and Human Services, Vendor Drug Program, Mail Code 2250, 4900 North Lamar Blvd., Austin, TX 78751.
Questions about this form should be directed to the VDP Pharmacy Benefits Access Help Desk at 800-435-4165.