CVS Caremark Payer Sheet - Supplemental to Medicare Part D Other Payer Amount Paid (OPAP) Billing - Updates, Changes & Reminders - Version 2.0.6

Sep 17, 2026

CVS Caremark payer sheet for Supplemental to Medicare Part D Other Payer Amount Paid (OPAP) billing, detailing updates to processing requirements and payer transaction structure. It defines plan and payer/processor information, effective and versioning dates, and NCPDP ECL version references. It provides pharmacy help desk contact guidance, then describes mandatory billing transaction segments and required data fields, including transaction header requirements and core identifiers for claim submission and reversals.

LanguageEnglish

CategoryForms

FormatPDF

Pages29

Reading Time10 min

AccessFree to download

HIGHLIGHTS - Updates, Changes & Reminders

PART 1: GENERAL INFORMATION

PART 2: BILLING TRANSACTION / SEGMENTS AND FIELDS

PART 3: REVERSAL TRANSACTION

PART 4: PAID (OR DUPLICATE OF PAID) RESPONSE

PART 5: REJECT RESPONSE

APPENDIX A: BIN / PC N COMBINATIONS

APPENDIX B: MEDICARE PART D

APPENDIX C: COORDINATION OF BENEFITS (COB)

APPENDIX D: COMPOUND BILLING

CVS Caremark Payer Sheet Supplemental to Medicare Part D Other Payer Amount Paid Table of Contents – HIGHLIGHTS – Updates, Changes & Reminders 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀖 PART 1: GENERAL INFORMATION 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀗• Pharmacy Help Desk Information 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀗 PART 2: BILLING TRANSACTION / SEGMENTS AND FIELDS 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀘 PART 3: REVERSAL TRANSACTION 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑 􀀔􀀖 PART 4: PAID (OR DUPLICATE OF PAID) RESPONSE 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑 􀀔􀀗 PART 5: REJECT RESPONSE 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀔􀀜 APPENDIX A: BIN / PC N COMBINATIONS 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀖• Primary BIN and PC N Values 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀖 APPENDIX B: MEDICARE PART D 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀗• Medicare Part D – Patient Residence 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀗• Medicare Part D – Prescriber NPI Requirements 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀘• Medicare Part D – Use of Prescription Origin Code 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀙• Medicare Part D – Vaccine Processing 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀙 APPENDIX C: COORDINATION OF BENEFITS (COB) 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀛• Submission Requirements for COB claims that are supplemental to Medicare Part D 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀛• Single Transaction COB (STCOB) 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑 􀀕􀀛 APPENDIX D: COMPOUND BILLING 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀕􀀜• Route of Administration Transition 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑􀀑 􀀑􀀑􀀑 􀀕􀀜 HIGHLIGHTS – Updates, Changes & Reminders This payer sheet refers to Supplemental to Medicare Part D Other Payer Amount Paid (OPAP) Billing. Refer to [www.caremark.com](www.caremark.com) under the Pharmacists & Medical Professionals link for additional payer sheets regarding the following: Commercial Primary Commercial Other Payer Patient Responsibility (OPPR) Commercial Other Payer Amount Paid (OPAP) Medicare Primary Billing & MSP (Medicare as Secondary Payer) Supplemental to Medicare Part D Other Payer Patient Responsibility (OPPR) ADAP/SPAP Medicare Part D Other Payer Patient Responsibility (OPPR) Medicaid Primary Billing Medicaid as Secondary Payer Billing Other Payer Patient Responsibility (OPPR) Medicaid as Secondary Payer Billing Other Payer Amount Paid (OPAP) | To prevent point of service disruption, the RxGroup must be submitted
on all claims and reversals. | | | --- | --- | The following is a summary of our new requirements. The items highlighted in the payer sheet illustrate the updated processing rules. Updated ECL Version to Oct 2024 PART 1: GENERAL INFORMATION Payer/Processor Name: CVS Caremark® Plan Name/Group Name: All Effective as of: October 2Ø25 Payer Sheet Version: 2.0.6 NCPDP Version/Release \#: D.Ø NCPDP ECL Version: Oct 2Ø24 NCPDP Emergency ECL Version: July 2Ø24 Pharmacy Help Desk Information Inquiries can be directed to the Interactive Voice Response (IVR) system or the Pharmacy Help Desk. (24 hours a day) The Pharmacy Help Desk numbers are provided below: | CVS Caremark® System | BIN | Help Desk Number | | --- | --- | --- | | Legacy ADV | *012114 | 1-8ØØ-364-6331 | | Legacy PCS | *012114 | 1-8ØØ-345-5413 | | FEP | 610239 | 1-8ØØ-364-6331 | | Legacy CRK | *012114 | 1-8ØØ-421-2342 | | Legacy PHC | 610468 | 1-8ØØ-777-1Ø23 | | Aetna | 610502 | 1-8ØØ-2

FAQs

What does the payer sheet cover for Medicare Part D billing?

It covers Supplemental to Medicare Part D Other Payer Amount Paid (OPAP) billing, including updated processing rules, transaction segments, and field requirements.

How should pharmacies submit the RxGroup to avoid point-of-service disruption?

The sheet states that the RxGroup must be submitted on all claims and reversals to prevent point-of-service disruption.

What are the key elements required in the billing transaction header?

The transaction header segment is mandatory, and the field table lists mandatory identifiers and data fields such as BIN number, version/release number, transaction code, processor control number, transaction count, and date of service.

Sep 17, 2026

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