RxNet v4 – Alpha Build – CVS #01631

Worker’s Comp

• Condor code: /1427
• ID number: Usually patient’s SSN
• Group: Usually not required

Full job aid

Car Insurance / AutoRx

• Condor code: /38635
• ID number: Claim # from the insurance
• Group: Carrier name (e.g., “erie”)

CVS Savings Finder Universal Code

• Condor code: /4444
• ID number: 4444
• Relationship: Cardholder

Employee Flu Vaccine

• Condor code: /26725
• ID number: Employee ID
• Group: RX0601

If Eligibility Check Returns “MEDCO BIN 610014 PCN COBSEG”

1. Write down the member ID from the eligibility result.
2. Exit results, return to 3rd party plan popup.
3. Enter Condor /4000 and select Medco Express Scripts 610014.
4. Use group: HMRK001

Narcan

• Condor code: /40885
• ID number: Naloxone
• Group: Naloxone
• Patient residence: 1 (home)
• Relationship: Cardholder

Enter appropriate line numbers to override COB sequence. After PA Naloxone Copay Assistance Program plan is added, $75 should deduct from copay.

Medicare Part B (Red, White & Blue Card)

• Condor code: /22345
• Diagnosis code: Z23 (Encounter for immunization)

Billable items:

• Blood glucose meter, strips, lancets (must bill meter first sometimes)
• CGMs — must bill reader before sensors
• Nebulizer solution (not devices)
• Anti-organ transplant rejection drugs
• Insulin for insulin pumps

Running eligibility with patient’s SSN may return Med A/B ID.

Some Medicare Part D plans show the Med B ID when processing test strips/lancets and viewing the TP popup.

Billing Freestyle Libre
Nebulizer solution billing
ABN Job Aid

Paxcess Patient Assistance Program

Only for: Medicare, Medicaid, Uninsured
Only while AssistRx cannot process TPPC 41395 claims.

What pharmacy teams need to know

1. Always bill patient’s primary insurance first.
2. If not covered or high copay → explain Paxcess program.
3. Patients can enroll online or by phone.
4. Bill Paxcess PAP using the provided ID after enrollment.

If AssistRx is unable to process:
Reject code 92 – Host Processing Error
Message: *CVS* PHARMACY MUST call PAXCESS

Obtain patient consent and mailing address → call Paxcess → prescription is mailed to patient at $0.

Receiving Checks From 3rd Party Payers

Forward checks to:

CVS PHARMACY, INC.
83649 Collection Center Dr
Chicago, IL 60693-0836