Get Cvs Caremark Prescription Reimbursement Claim Form. Cvs Caremark Prescription Reimbursement Claim

This guide provides clear instructions on how to complete the CVS Caremark Prescription Reimbursement Claim Form. Following these steps will assist you in ensuring proper reimbursement for your prescription expenses.

Follow the steps to successfully fill out the CVS Caremark Prescription Reimbursement Claim Form.

1. Click ‘Get Form’ button to access the CVS Caremark Prescription Reimbursement Claim Form and open it for editing.
2. Complete the card holder/patient information section. This includes providing the identification number, group number, and personal details such as name, address, and phone number. Ensure that you fill in all required fields accurately.
3. For patient information, use a separate claim form for each patient. Fill in the patient’s name, date of birth, relationship to primary member, gender, and phone number.
4. Provide details on other insurance information. Indicate if any medicines are related to an on-the-job injury, and if covered by other insurance. If yes, include the name of the insurance company and ID number.
5. Sign the form where required, certifying that the information provided is accurate and that medicines have been received.
6. Gather all original pharmacy receipts needed for the claim. Ensure they include the patient name, prescription number, medication NDC number, date of fill, metric quantity, total charge, and days' supply. Cash register receipts are only valid for diabetic supplies.
7. Obtain the prescribing physician’s NPI number and fill in their contact information.
8. Mail your completed claim form and all attachments to the appropriate CVS Caremark Claims Department address listed on the form, based on your RXBIN number.
9. Finally, make a copy of all submitted documents for your records. Save changes, download, print, or share the form as needed.

Start completing your CVS Caremark Prescription Reimbursement Claim Form online now to ensure you get the reimbursement you need.