Anthem Blue Cross Blue Shield PPO Plan - Teamworks at Home ...

Pre-service claims
If the Plan requires preauthorization in order to
receive benefts, fax your pre-service claim request to
1-888-836-0730�
Post-service claims
You will need to fle a claim if you buy prescription
drugs or other covered supplies from a pharmacy
not in the CVS Caremark network or if your network
pharmacy was unable to submit the claim successfully�
All claims must be received by CVS Caremark within
one year from the date the prescription drug or covered
supplies were dispensed�
Your out-of-network claim will be processed faster if you
follow the correct procedures� Complete the Prescription
Drug Reimbursement form and send it with the original
prescription receipts� You may not use cash register
receipts or container labels from prescription drugs
purchased at an out-of-network pharmacy�
Prescription drug bills must provide the following
information:
• Patient’s full name
• Prescription number and name of medication
• Charge and date for each item purchased
• Quantity of medication
• Doctor’s name
To get a claim form:
• Go to caremark�com, sign on, click Forms & Tools, and
download the claim form�
• Call Customer Care at 1-800-772-2301 to request
a form�
Send your claim to:
CVS Caremark
PO Box 52196
Phoenix, AZ 85072
You are responsible for any charges incurred but not
covered by the Plan�
Please refer to “Appendix A: Claims and appeals”
in your Benefts Book for more information
regarding claims�
CVS Caremark claims questions, denied
coverage, and appeals
If you have a question or concern about a claim already
fled with CVS Caremark, you may contact Customer
Care before requesting an appeal�
You may also fle an appeal with CVS Caremark without
frst contacting Customer Care� An appeal must be
fled within 180 days from the date of receipt of the
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initial denial regardless of any verbal discussions that
have occurred regarding your claim� Once you exhaust
the internal appeals procedures, you are entitled to an
external review of your claim�
Complete information on appeals is provided in the
Benefts Book, “Appendix A: Claims and appeals�”
Other things you should know
Drug safety
The risks associated with drug-to-drug interactions
and drug allergies can be very serious� Whether you
use CVS Caremark Mail Service or a participating
retail pharmacy, CVS Caremark checks for potential
interactions and allergies� CVS Caremark also sends
this information electronically to participating
retail pharmacies�
CVS Caremark may contact your doctor about
your prescription
CVS Caremark can dispense a prescription only as
it is written by a physician or other lawful prescriber
(as applicable to CVS Caremark)� Unless you or your
doctor specifes otherwise, CVS Caremark dispenses
your prescription with the generic equivalent when
available and if permissible by law (as applicable to
CVS Caremark)�
You are not limited to prescriptions on CVS Caremark’s
Primary/Preferred Drug List, but you will probably
pay less if you choose a drug from that list� If your
doctor prescribes a drug that is not on the Primary/
Preferred Drug List but there’s an alternative on the list,
CVS Caremark may contact your doctor to see if that
drug would work for you� However, your doctor always
makes the fnal decision regarding your prescriptions�
If your doctor agrees to use a preferred drug, you will
never pay more than you would have for the original
prescription, and will usually save money�
Also, CVS Caremark ofers consultative services to
help manage chronic or long-term conditions, such
as diabetes� These services may help you save on
pharmacy costs and may help to prevent related
complications or disease progression� Through this
program, you and your doctor may be contacted via
telephone by a CVS Caremark pharmacist to discuss
your therapy and provide condition and drug-specifc
counseling�
Prescription drug rebates
CVS Caremark administers the prescription drug
beneft on behalf of Wells Fargo, but because the
Plan is self-insured, all claims are paid by the
company through our claims and prescription
drug administrators�
Anthem Blue Cross Blue Shield PPO Plan