Documents
Instructions
Update: 7/2022
Purpose
Managed care organizations (MCO) use this form to submit revisions to HHSC of the pharmacy resources available at txvendordrug.com.
When to Prepare
MCOs staff complete one copy of the form per managed care program (e.g., submit one form for STAR, CHIP, STAR+PLUS, etc.).
Detailed Instructions
Fields not applicable to your MCO program should remain blank.
- Contact Information
- MCO submitter completes all fields.
- MCO General Information
- Complete all fields, and identify the managed care program applicable to this form.
- Claims Billing Information.
- Complete all fields as necessary. Identify the "BIN Number" (field 1Ø1-A1), "Processor Control Number" (1Ø4-A4), and "Group ID" (field 3Ø1-C1) pharmacies staff use to submit claims to the MCO.
- Pharmacy Enrollment Information.
- Complete all fields as necessary.
- DME Enrollment Information.
- Complete all fields as necessary.
- Call Center Information.
- Complete all fields.
- Website Information.
- Complete all fields as necessary.
Transmittal
The MCO sends the form to the Vendor Drug Program via email at vdp_mco_solutions@hhsc.state.tx.us.
Questions
- MCO staff with questions should email vdp_mco_solutions@hhsc.state.tx.us.