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HHSC to Reject Pharmacy Claims for Inaccurate License Information Beginning September 28, 2022

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On May 2, 2022, the Texas Health and Human Services Commission (HHSC) announced that pharmacies should begin updating their license information in the Provider Enrollment and Management System (PEMS).

Beginning September 28, 2022, HHSC and managed care organizations (MCOs) will reject pharmacy claims if the pharmacy license information in PEMS is incorrect. Pharmacies should begin reviewing their pharmacy’s license information in PEMS as soon as possible to prevent claim rejections. If the license information is incorrect, a maintenance request must be submitted through PEMS to make corrections.

The Texas Medicaid & Healthcare Partnership (TMHP) reviews license information during the enrollment process, and HHSC and MCOs review the pharmacy license information as part of the claims adjudication process.

For more information, call the TMHP Contact Center at 800-925-9126.