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December 2016 Texas Medicaid Provider Procedures Manual

Appendix B: Vendor Drug Program : B.1 Vendor Drug Program : B.1.9 Cost Avoidance Coordination of Benefits

B.1.9
Cost avoidance coordination of benefits (COB) for pharmacy claims ensures compliance with the Centers for Medicare & Medicaid Services (CMS) regulations. Under federal rules, Medicaid agencies must be the payer of last resort. The cost avoidance model checks for other known insurance at the point of sale, preventing Medicaid from paying a claim until the pharmacy attempts to obtain payment from the client’s third party insurance.
Refer to:
VDP Pharmacy Provider Procedure Manual at www.txvendordrug.com/about/policy.

Texas Medicaid & Healthcare Partnership
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