Pharmacy Prior Authorizations
PCHP is contracted with Navitus Health Solutions to administer pharmacy benefits for PCHP CHIP and STAR members. Members may obtain their medications at any network pharmacy unless HHSC has placed the member in the Office of Inspector General (OIG) Lock-in program.
For questions related to the formulary, the preferred drug list, billing, prescription overrides, prior authorizations, quantity limit or formulary exceptions, call Navitus at 1-877-908-6023 or access the Navitus website at www.navitus.com.
To access the necessary form, all the provider needs is his/her NPI number. Completed forms can be faxed 24 hours a day, seven days a week, to Navitus at 920-735-5312.
Prescribers can also call Navitus Customer Care to speak with the Prior Authorization department between 8 a.m. and 5 p.m. CST to submit a PA request over the phone. After hours, providers will have the option to leave a voicemail.
Claim PCN: MCD
STAR Claim Group – PHS
CHIP Claim Group – PHC
Prior Authorization Timelines
- Standard request: The decision to approve or deny a standard request for PA is made within 24 hours of receipt of all necessary information.
- Urgent request: The decision to approve or deny an urgent request for PA is made within 24 hours of receipt of all necessary information.
- If a decision cannot be reached within 24 hours, a 72-hour supply of medication may be dispensed by the retail pharmacy or hospital without PA through the use of an override code while awaiting a PA decision
Providers must download the form Pharmacy – Texas Standard Prior Authorization Request.
Click Here to obtain the appropriate drug criteria from the Vendor Drug Program (VDP) website.
Parkland has a single sign on for all Texas Medicaid and CHIP clinical edits. All Clinical edits are updated as required and managed appropriately.
- Clinical Edits are now at this address: https://txstarchip.navitus.com/pages/clinical-edits.aspx
- PA forms (STAR/CHIP): https://txstarchip.navitus.com/pages/prior-authorization-forms.aspx
- Formularies (STAR/CHIP): https://txstarchip.navitus.com/pages/formulary.aspx
- Synagis info: https://txstarchip.navitus.com/pages/synagis.aspx