Client Eligibility Resources

For additional resources please refer to the Client Eligibility (PDF) chapter of the VDP Pharmacy Provider Procedure Manual (PPPM).

Real Time Verification

The NCPDP Eligibility Verification (E1) Transaction is submitted through the pharmacy’s point-of-sale system.  Contact your software company to ensure the “Additional Message Information” field (526-FQ) is returned for all E1 transaction responses.

The VDP Eligibility Verification Portal (EVP) is a browser-based application that is free for all contracted pharmacy providers.  Pharmacy staff must complete the Eligibility Verification Portal (EVP) Access Form (PDF) to register and return the completed form

Refer to the payer specification documents for an explanation of the expanded messages on all real-time inquiries.

Your Texas Benefits

The Your Texas Benefits Medicaid ID card is what Medicaid clients should present when visiting a doctor or dentist office, a clinic, or pharmacy for Medicaid services. YourTexasBenefitsCard.com is the provider portal used to verify Medicaid eligibility and access Medicaid client’s available health information. The specific functions of the portal include:

  • Verification of Medicaid clients’ eligibility and the ability to view client program information
  • View Medicaid clients’ Health Summary and Vaccination information
  • View Medicaid clients’ Prescription History
  • View Medicaid clients’ THSteps Alerts listing the last check-up dates for dental/medical services
  • View Medicaid clients’ health events, including diagnosis and treatment, plus lab results

While prescribers may verify Medicaid eligibility, view clients’ medical or dental plan and available health information online at YourTexasBenefitsCard.com, pharmacists and other pharmacy staff should use one of the Vendor Drug real-time eligibility verification tools to obtain outpatient pharmacy eligibility and prescription benefit information.

Providers and pharmacy staff can call the YourTexasBenefitsCard Provider Help Desk at 1-855-827-3747 to find enrollment status and the name of the client’s health plan. Pharmacy staff should select Option 3 and follow the applicable prompts. Refer to the Provider Help Desk User Guide, below, for further information. Please have the cardholder ID and date of birth ready to expedite your call.