This form is used by managed care organization (MCO) staff to provide updates or corrections to the managed care pharmacy resources available at txvendordrug.com, specifically the:
- Pharmacy MCO Enrollment Chart
- Pharmacy MCO Assistance Chart
- Prescriber MCO Assistance chart
When to Prepare
- The form is only for use by MCO staff.
- For the Pharmacy Enrollment section:
- MCO staff provide the phone number, fax number, email address or website that pharmacies will use for MCO pharmacy enrollment.
- MCO staff provide the phone number or email address that pharmacies will use for MCO durable medical equipment enrollment.
- For the Pharmacy Assistance section:
- MCO staff provide the "BIN Number" (field 1Ø1-A1), "Processor Control Number" (1Ø4-A4), and "Group ID" (field 3Ø1-C1) that pharmacy staff will use to submit claims to that MCO.
- MCO staff provide the phone numbers for the Pharmacy Call Center, Prior Authorization Call Center and Member Call Center.
- For the Prescriber Assistance section:
- The phone numbers for the Prior Authorization Call Center and Member Call Center are identical to those submitted in the Pharmacy Assistance section.
MCO staff sends the form to the Vendor Drug Program via email at firstname.lastname@example.org.
- MCO staff with questions should email email@example.com.