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Silverscript reimbursement form

Silverscript reimbursement form 2025

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The document provides instructions for submitting a Medicare Part D Prescription Claim Form, detailing the necessary patient information, prescription details, and submission requirements. It emphasizes the importance of including original pharmacy receipts, avoiding staples or tape on documents, and ensuring all information is accurate to prevent fraud. Additionally, it outlines steps for reimbursement processing and reminders for using network pharmacies.

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Click ‘Get Form’ to open the silverscript reimbursement form in the editor.
Begin by filling out the Patient Information section. Ensure you provide your Identification Number, Group No./Name, and personal details such as your name, address, date of birth, and phone number. This information is crucial for processing your claim.
In the 'Tell us about your prescriptions' section, answer the questions regarding any assistance programs or other insurance plans. Be sure to indicate if any prescriptions were filled under special circumstances.
For each prescription you are submitting, complete the required fields including Prescription Number, Drug Name, NDC Number, Date Filled, Total Paid, Quantity of Drug, and Days Supply. If you have more than three prescriptions, utilize the Additional Prescription Information page.
Finally, provide any additional comments or information in Step 3. Remember to sign and date the form before submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Are SilverScript and Caremark the same?

Caremark Rx In March 2007, Caremark merged with CVS Corporation to create CVS Caremark. The Nashville office was closed following the merger. In 2014, the corporate name for CVS Caremark became CVS Health, with CVS Caremark becoming a subsidiary.

Are CVS Caremark and SilverScript the same?

Follow the steps given below to file a reimbursement health insurance claim: Step 1: Inform the Insurance Company. Step 2: Obtain Treatment. Step 3: Pay the Hospital Bill. Step 4: Collect All Your Documents. Step 5: Fill up the Claim Form. Step 6: Submit All Documents to the Insurance Company.

What is the new name for SilverScript?

You will see the new plan name on materials and letters we send you. But this will not impact your ability to use your ID card to fill prescriptions. When using online tools, remember to select SilverScript SmartSaver as the plan name. In 2023, the national average monthly plan premium for SmartSaver is just $5.92.

How to claim reimbursement form?

Form CMS-1696 can be downloaded at .cms.gov or obtained by calling the Customer Service number on your card. The claim may be submitted via mail or fax to the address or phone number on the Medicare Part D Prescription Drug Claim Form. Reimbursement requests may be submitted up to 36 months from the date of service.

Which pharmacy does SilverScript use?

Each SilverScript plan provides low copayments for generic drugs and a comprehensive drug list (formulary). All SilverScript plans have access to Aetnas wide network of pharmacies, as well as the CVS Caremark Mail Service Pharmacy.

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How do I get reimbursed for Medicare Part D?

Just give us a call at 1-833-570-6670 (TTY:711) 8AM-8PM, 7 days a week.