Transcription of CVS CAREMARK PAYER SHEET
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CVS CAREMARK PAYER SHEET
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 .. 13 PART 5: REJECT RESPONSE .. 18 APPENDIX A: BIN / PCN COMBINATIONS .. 22 Primary BIN and PCN Values .. 22 APPENDIX B: Sales Tax Submission .. 23 Sales Tax Billing Claim Submission .. 23 APPENDIX C: VACCINE PROCESSING .. 24 commercial Vaccine Processing .. 24 APPENDIX D: COMPOUND BILLING.
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
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