CVS CAREMARK PAYER SHEET

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CVS CAREMARK PAYER SHEET commercial Primary 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 ........................................ .............................. 11 PART 4: PAID (OR DUPLICATE OF PAID) RESPONSE.

Commercial Other Payer Amount Paid (OPAP) ... 455-EM Prescription/Service Reference Number Qualifier 1 M 1 – Rx Billing 4Ø2-D2 Prescription/Service Reference Number M Rx Number 436-E1 Product/Service ID Qualifier Ø3 M If billing for a multi-ingredient

  Prescription, Commercial, Caremark