Pharmacy

• Reimbursement research and claim status (payment information including check # and date)
• Reject Code Assistance for Exception Claim Errors & Patient Benefit Errors
• Download 835 Authorization Form to submit at Esiprovider.com
• Pricing Appeal for AWP or MAC
• Provider Manual
• Claim Reversals
• Payer Sheets

• Pharmacy name
• NCPDP or NABP #
• Address (city, state, zip)
• Phone number
• Contact name
• Member name and ID
• Dispense date
• Drug name and NDC #

• Submit an application to join our pharmacy networks (new pharmacies or changes in ownership)
• Request a change in your PSAO/GPO status. Please allow up to 60 days to process your request.
• Re-credentialing notifications for renewal
• Demographic changes (change of address, contact information, and change of affiliation)
• Request EFT – 835 Electronic Remits (Upload form from PRC website)

To request a missing 835 Reconciliation report or inquire about a remit set up or status please email remittance@express-scripts.com.

• Pharmacy name
• NCPDP or NABP #
• Address (city, state, zip)
• Phone number
• Contact name

• Check status of credentialing and contracting process
• Change in PSAO/GPO questions before applying on ESIProvider.com
• Return missing items requested during the contracting and credentialing process or fax to 1 (866) 515-3482.
• For additional questions and clarification before submitting any applications.

• Pharmacy name
• NCPDP or NABP #
• Address (city, state, zip)
• Phone number
• Contact name

• Return signed documentation for contracting and credentialing only or fax to 1 (877) 391-6213. Please allow up to 30 business days to process your request.