Resources to identify whether a client is enrolled in Medicaid, CHIP, KHC, or the CSHCN Services Program, and whether the client is eligible to receive pharmacy services through the Vendor Drug Program or Medicaid Managed Care.
Client Eligibility Resources
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.
- Questions and answers for clients
- Questions and answers for providers (PDF)
- Questions and Answers for stakeholders
- Provider Help Desk User Guide (PDF)