Texas Prior Authorization Call Center
This Texas Prior Authorization Call Center is for Fee-For-Service Medicaid clients. Only the prescribing physician or a staff representative can request authorization for non-preferred drugs or clinical edit criteria.
Authorization processes and call centers may vary by health plan for managed care clients.
HHSC contracts with Health Information Designs, LLC. for call center and enhanced formulary services.
For non-preferred drug and clinical edit authorization requests.
(Monday-Friday, 7:30 a.m. to 6:30 p.m. central time)
The call center requires certain information to quickly assess each request as outlined in the Provider Quick Reference. Requests with missing information will not be assessed until that information is provided. If the authorization request is approved then the client can return to their pharmacy to obtain the prescription. The claim will pay and no further action will be required. If the authorization request is denied then the prescribing physician's office will be notified. In addition:
- A 72-hour emergency supply of a prescribed drug must be provided when a medication is needed without delay and authorization is not available. The emergency override claim can be used for both fee-for-service and managed care members. Pharmacy staff are encouraged to post these instructions in your pharmacy for reference and to reproduce this information for staff education.
- The prescriber has the option of prescribing a different treatment course that does not require prior authorization or submitting the Reconsideration Request Form. Determination of the reconsideration will be mailed to the requesting prescriber and client.
- The enhanced formulary at PAXpress identifies Medicaid formulary drugs and the clinical edit criteria used to evaluate a prior authorization for a specific drug and the alternate therapies (where applicable) that are allowed.
- Clinical prior authorization criteria documents are maintained online at PAXpress.
- If PAXpress is unavailable please contact the Texas Prior Authorization Technical Helpdesk at 1-334-321-0177.