We’re here to help. For questions related to processing a retail pharmacy prescription claim, call the toll-free number listed below.
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Providers will be paid only for claims in which a prescription for a covered item is written by a prescriber for an eligible person and is dispensed to that person. CVS/caremark and/or plan sponsors will provide eligible persons with identification cards. Providers must request the ID card from the eligible person and utilize the information on the card to submit claims. Providers will not be paid for providing pharmacy services related to covered items to an eligible person whose eligibility was not correctly submitted.
In most cases, identification cards will be produced in the National Council for Prescription Drug Programs (NCPDP) format and will contain the eligible persons’ ID number, the bank ID number (RXBIN) and the group (RXGRP) and/or the processor control number (RXPCN). Some plan sponsors produce ID cards that may or may not include the information highlighted above. An ID card may show coverage for the eligible person only or it may show coverage for the eligible person and his or her dependents.
Inquiries for which the CVS/caremark Provider Manual or the claim system response does not address can be directed to the Interactive Voice Response (IVR) system or to one of the CVS/caremark Help Desks. The IVR is available 24 hours a day, 7 days a week, excluding downtime for maintenance and service.
Help Desk representatives will use reasonable efforts to assist providers. During normal business hours, a licensed pharmacist will also be available to answer questions. However, the pharmacist will not be able to provide any professional advice with respect to the provision of Mail Services.
Send inquiries, grievances and requested changes about the information communicated in the CVS/caremark Provider Manual and/or CVS/caremark documents, or any other questions to: