Appropriate Billing of Medications

Purpose of communication: The CVS Caremark® Pharmacy Audit Department is providing network pharmacies with basic information on the appropriate billing of nasal spray medications to help prevent audit discrepancies and non-compliance with the CVS Caremark Provider Manual and Centers for Medicare and Medicaid Services (CMS) requirements.

Appropriate Billing of Medications

Please find attached updated Patient Choice/Therapy First/Therapy First Plus vD.0 payer sheets.  

Effective IMMEDIATELY, Change Healthcare will require you to submit components of Patient Pay Amount using Other Payer Patient Responsibility Amount Qualifiers 01 – 05, 07 -13 in field 351-NP.  

Please disregard this notice if you currently submit these components.   

Sincerely,  

Change Healthcare Provider Relations

This week's advocacy update includes details on the federal opioid bill passed by the Senate, clarification of compounding inspection procedures, and more!

Slides from the recent APNS webinar covering CVS Caremark DIR fee changes are now available in PDF format.