CVS CAREMARK PAYER SHEET

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CVS CAREMARK PAYER SHEET Medicare Primary Billing & MSP (Medicare as Secondary PAYER ) 12/29/2021 Page 2 of 32 Table of Contents HIGHLIGHTS Updates, Changes & Reminders ........................................ ........................................ .. 3 PART 1: GENERAL INFORMATION ........................................ ........................................ ....................... 4 Pharmacy Help Desk Information ........................................ ........................................ ................ 4 PART 2: BILLING TRANSACTION / SEGMENTS AND FIELDS ........................................ ................ 5 PART 3: REVERSAL TRANSACTION ........................................ ........................................ .................. 13 PART 4: PAID (OR DUPLICATE OF PAID) RESPONSE.

34Ø-7C Other Payer ID RW Required when identification of the Other Payer is necessary for claim/encounter adjudication 443-E8 Other Payer Date RW Required when identification of the Other Payer Date is necessary for claim/encounter adjudication – CCYYMMDD 341-HB Other Payer Amount Paid Count Max of 9 RW Required when Other Payer Amount Paid ...

  Payer, Caremark, Payer id, Caremark payer