Provider News
Agenda for April Drug Utilization Review Board Meeting Now Available
The Texas Drug Utilization Review Board agenda for Friday, July 25, 2025, is now available. Refer to the Texas Drug Utilization Review Board Handbook for instructions on submitting written materials to the board before the meeting and public testifying on the day of...
UPDATED: Pharmacy Claim Guidance Following Texas Hill Country Flooding
On Friday, July 4, 2025, severe flooding impacted communities in the Texas Hill Country. The Vendor Drug Program provided pharmacy claims guidance related to refill too soon rejections. Pharmacies may contact the Texas Medicaid Pharmacy and Technical Call Center at...
Semi-annual Medicaid Preferred Drug List Update Scheduled for July 28, 2025
HHSC will publish the semi‑annual update to the Texas Medicaid Preferred Drug List (PDL) on July 28, 2025. These changes are based on recommendations from the January 2025 and April 2025 Texas Drug Utilization Review (DUR) Board meetings. The updated PDL and PDL...
Payspan Portal Production Maintenance – Saturday, July 19, 8:00 P.M. (ET) through Sunday, July 20, 9:00 A.M. (ET)
Zelis® is utilizing a maintenance window for the Payspan Portal on Saturday, July 19, 8 P.M. (ET) through Sunday, July 20, 9 A.M. (ET). Note: If the maintenance activities are completed before 9 A.M. (ET), we will end the maintenance early. The following System...
Rider 32 Implementation Information
Beginning September 1, 2025, the Texas Health and Human Services Commission (HHSC) will transition Medicaid-only services for dually eligible clients (clients who are eligible for both Medicare and Medicaid) enrolled in Medicaid managed care from a fee-for-service...
Rural Emergency Hospitals To Be Recognized As New Provider Type
Texas Health and Human Services Commission (HHSC) will allow Providers to enroll in Texas Medicaid as Rural Emergency Hospitals (REH) effective September 1, 2025. Community First Health Plans will implement the appropriate system and operational change requirements...
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