Pharmacy Prior Authorizations
PCHP is contracted with Navitus Health Solutions to administer pharmacy benefits for STAR Medicaid and CHIP members. Members may obtain their medications at any network pharmacy unless Texas 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 website at www.navitus.com.
To access the necessary form, providers will need their NPI number. Completed forms can be faxed to Navitus at 920-735-5312, 24 hours a day, seven days a week.
Prescribers can also submit a prior authorization request over the phone by calling Navitus Customer Care and speaking with the Prior Authorization department between 8 am and 5 pm CST. After hours, providers will have the option to leave a voicemail.
Claim PCN: MCD
STAR Claim Group – PHS
CHIP Claim Group – PHC
Pharmacy Prior Authorization Timelines
Standard request: A prescriber can submit a Prior Authorization Form to Navitus via U.S. Mail or fax, or they can contact our call center to speak to a Prior Authorization Specialist. The request will be processed as quickly as possible once all required information has been provided.
Urgent request: A prescriber may notify Navitus by phone or fax of an urgent request submission. A decision will be made within 24 hours of receipt. The member and prescriber are notified as soon as the decision has been made.
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 prior authorization through the use of an override code while awaiting a prior authorization decision.
Providers must download the Pharmacy – Texas Standard Prior Authorization Request form .
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: https://txstarchip.navitus.com/pages/clinical-edits.aspx
- Prior Authorization 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
Need help with authorizations and more? Please call our Provider Customer Service line at 1-888-672-2277 (HEALTHfirst/STAR Medicaid) or 1-888-814-2352 (KIDSfirst/CHIP, CHIP Perinate). Hours of operation are 8 am - 5 pm CST, Monday - Friday (except state holidays).