TX HHS Form 1319. Pharmacy Claims Billing Request

The TX HHS Form 1319 is a Pharmacy Claims Billing Request submission form used by pharmacies to request payment for prescription claims under the Texas Vendor Drug Program. This form serves as a crucial tool for pharmacies to provide detailed information about each claim, including patient demographics, medication details, and billing information.

This comprehensive form requires pharmacies to submit relevant data points, such as the patient's name, date of birth, and National Provider Information (NPI), as well as information about the prescription itself, including the product ID (NDC), quantity dispensed, and number of days supply provided. The form also includes sections for prior authorization, professional services code, and result of service code, among others.

The TX HHS Form 1319 is issued by the Texas Health and Human Services (HHS) agency, which oversees the Vendor Drug Program. This program aims to provide a standardized process for pharmacies to submit claims and receive payment for prescription medications. By completing this form accurately and submitting it in a timely manner, pharmacies can ensure that their claims are processed efficiently and effectively.