Payment and Eligibility Integration
project
83a8139b6924b807
Normalized: payment and eligibility integration
moreland_contracts
Entity Properties (gold project table)
project_id
83a8139b6924b807
name
Payment and Eligibility Integration
client_id
—
canonical_metadata
—
created_at
2026-02-12 05:36:54.288209+00:00
updated_at
2026-02-12 05:36:54.288209+00:00
status
—
billable
—
recurring
—
squad
—
qa_partner
—
project_manager
—
lead_dev
—
description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
state
—
team_name
—
closedate
—
dealstage
—
contract_type
fixed_fee
contract_hourly_rate
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contract_estimated_hours
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contract_total_fee
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53%
Separation Confidence
How distinct this entity is from others. Higher means no close matches existed when it was created. Lower means a near-match was rejected just below the 80% threshold — worth reviewing.
Moderate — a somewhat similar entity exists
95%
Avg Match Confidence
The average confidence score across all active source mappings. Shows overall quality of linkage between source records and this canonical entity.
Strong source linkage
Source Mappings (95)
| Source | Source ID | Display Name | Confidence | Method | Status | Actions | |
|---|---|---|---|---|---|---|---|
| moreland_contracts | ImHtTW6WYUu4xg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-02-21T18:03:38.577849+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | lI0agCMfUb9zoA | Payment and Eligibility Integration | 1.00 | exact | Active |
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|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system to ensure compliance with NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-03-06T00:03:36.293859+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | bcGeKNhPESQ6aQ | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-06T02:03:48.568969+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | gxRdwa7v4iJcUg | Payment and Eligibility Integration | 1.00 | exact | Active |
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|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-03-06T06:03:23.429769+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | +7DPVALQZTxkHQ | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-03-04T12:03:36.236336+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | Rpy79jvKjQ7gvw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-04T00:03:32.940475+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | QGxH6D6aBlz9og | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information in the NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-03-02T17:46:55.002577+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | np09c1Q1h0f+7g | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-26T12:03:50.219481+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | iljaFIuOehRm8Q | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-26T02:04:04.262642+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | HrOZyJDTz47KEQ | Payment and Eligibility Integration | 1.00 | exact | Active |
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-21T02:04:10.116098+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | G3cPRspJqVk8GQ | Payment and Eligibility Integration | 1.00 | exact | Active |
|
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|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-22T02:04:01.886774+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | kde5+xWucjBqDQ | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-21T00:04:04.367805+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | /MNrg7CLT5Fg+A | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system to ensure compliance with NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-02-21T12:03:36.257898+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | 6bIPr5ybOFBvqg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-02-20T06:03:36.396324+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | BwW0CRbLm3/YFg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-20T00:03:24.910007+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | UGX3axfpOV6kAA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-21T06:03:34.356810+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | 6nUZ6RaKS6Nvow | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-03T18:03:41.053131+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | +EklwABLOeEAVw | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of payment and eligibility information in the NCPDP D.0 format for CVS.
start_date
—
extracted_at
2026-02-26T18:03:31.336145+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | 5aBCJzjdYCJlfA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
—
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information in the NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-03-03T12:02:51.591663+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | HOI6YWw1MpvlWA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-02T18:03:17.859019+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | lpei8LE0ElijmA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of payment and eligibility information in the NCPDP D.0 format for CVS.
start_date
—
extracted_at
2026-02-22T12:03:36.188024+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | XWIXrlCUX6rgBA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-02-19T03:07:52.290872+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | pvVz3/WzFd9XDA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system to ensure compliance with NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-03-26T02:04:58.140974+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | 373//uPv1VMFpQ | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-02-20T12:03:42.781223+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | Q+Lo91+EkHwg/A | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-02-25T18:03:57.261707+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | tWuxQLyr6MHO7Q | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
—
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-05T02:03:54.697157+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | pHI2XTdU1U8yXw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-03-19T21:20:19.639189+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | t32uFWg10kdl9g | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-04-06T02:04:04.236511+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | yZLIRZ/n0qcF/w | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-10T02:04:14.851869+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | 43AX2n0wjTd8aw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-11T02:03:44.526774+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | rc3O5ff+XnDRYg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-12T02:03:20.691065+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | bJ3WWXic3KQ1VQ | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-13T02:03:53.480460+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | YkPY++gHNFOiUw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-04-14T02:04:08.739750+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | JsEdaSJpgKLDBg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information in the NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-04-16T02:03:54.095804+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | ok4JXWQSgOPX5g | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-04-17T02:03:42.094932+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | VT4JL41BdAW62w | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-04-18T02:03:55.285294+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | 23FUu2hEUxSRrg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-19T02:03:31.053360+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | KrjG8z683d0MMw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-04-09T02:03:42.760035+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | t54CbqlevdpFJA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-25T00:03:25.891615+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | w2eHXrnWLfWLYA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-19T15:15:11.125021+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | cnTy5/s8YmJf9w | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-23T02:04:03.948177+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | Ze/HqrYcDdrpEg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-04-08T21:06:48.546862+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | ii0wmxml1ltwUA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
—
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-02T02:04:03.866429+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | 766uOK77dttFkw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-01T02:04:35.301267+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | LOvSwoDeRG5tGA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-03-28T02:04:18.321956+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | kXPvHxiY5vduDw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-03-21T02:04:04.894934+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | jwd9W4DnH2Ot6Q | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-06T12:03:36.228255+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | UVrVK/eZkK19HA | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-25T02:03:59.343117+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | UvSSY5zjz0yeMw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system to ensure compliance with NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-02-23T02:04:07.419117+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | BCNWzLhqF/vMwg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-19T03:09:58.385493+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | oDjMvxFhvLlQMw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-24T02:04:12.997786+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
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2025-08-13T03:04:30+00:00
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Jeff Kavlick
modified_by
Jeff Kavlick
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—
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| moreland_contracts | wN98ZwpqY+hY0A | Payment and Eligibility Integration | 1.00 | exact | Active |
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bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-08T02:04:11.883678+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | viE7UMHSX2fIRw | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-07T02:04:06.999140+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | 2vR6KsQkWqN5fQ | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-27T02:04:13.665367+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | D/F9VHDZwNFSRA | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-03-05T00:03:04.074246+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | uUjITeeu8SsnKg | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-05T06:03:23.327471+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | 2XyRMM0j7sy/Gg | Payment and Eligibility Integration | 1.00 | exact | Active |
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|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-03-04T02:04:18.082618+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | sKxiM8TWpX3yUQ | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-04T18:03:38.591286+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | UopWBwFxKD8CXw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information in the NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-03-02T17:47:03.196822+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | eCtGZk6U3HdqJw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-03-03T06:03:19.148284+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | BDD4UxYkyn81wQ | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-26T06:03:59.486651+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | ydL4fhP/fzUFHw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information in the NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-02-25T12:03:38.981602+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | qDrQYIH5YtNtdQ | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-24T12:03:38.712394+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | OBOOPw1VXa8ksw | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-23T00:04:03.343286+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | 0ipzJ5PWYT4IHw | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-20T18:03:32.156567+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | b5S2LtN2+foMjg | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-20T02:04:26.688506+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | TQw5wKV7yE6NUQ | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-19T18:03:48.716709+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | hnifG2s6S32YtQ | Payment and Eligibility Integration | 1.00 | exact | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-25T06:03:45.676892+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
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Jeff Kavlick
modified_by
Jeff Kavlick
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bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-20T02:03:55.071187+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | VCUYpTFvvGKfsw | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-03-25T02:04:40.861918+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | /a1cOi8dw/NjhA | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-03T02:03:48.891813+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | LAz+nq2Jw4y6Bw | Payment and Eligibility Integration | 1.00 | exact | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-31T02:04:22.200467+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
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| moreland_contracts | B7BZ6u9v0DGDjQ | Payment and Eligibility Integration | 1.00 | exact | Active |
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bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS payment and eligibility information in the NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-03-05T12:03:40.049110+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
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bronze_moreland_contracts_ma_project_contracts
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d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system with Nox to ensure compliance with NCPDP D.0 pharmacy claim format.
start_date
—
extracted_at
2026-02-24T06:03:38.931533+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-04-04T02:03:58.788425+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
—
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-23T06:04:20.010777+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | OKze43h4ttRzpA | Payment and Eligibility Integration with Nox | 0.80 | fuzzy+embedding | Active |
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|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system with Nox to ensure compliance with NCPDP D.0 pharmacy claim format.
start_date
—
extracted_at
2026-03-24T02:04:08.415064+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
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Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | fhnrWVtRI72zNg | CVS Payment and Eligibility Integration | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-22T06:03:20.857323+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | 9tjOG1TjolZQVg | Payment and Eligibility Integration with Nox | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system to ensure compliance with NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-04-05T02:03:54.606378+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | pOAmZ9XxxH76Dg | CVS Payment and Eligibility Integration | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-04T06:04:09.819172+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | GdhQ0p5dV+bzsA | CVS Payment and Eligibility Integration | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-03-03T02:04:05.365127+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | nC/gAw2StJELig | CVS Payment and Eligibility Integration | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-02-22T00:03:28.682617+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | EKuVtAhU8EoYIQ | Payment and Eligibility Integration with Nox | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system with Nox to ensure compliance with NCPDP D.0 format for pharmacy claims.
start_date
—
extracted_at
2026-04-09T13:57:34.718205+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | igj352rYJKhUdg | Payment and Eligibility Integration with Nox | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system with Nox to ensure compliance with NCPDP D.0 pharmacy claim format.
start_date
—
extracted_at
2026-02-19T12:04:05.769892+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | jZdDYmiUWH8M/g | CVS Payment and Eligibility Integration | 0.80 | fuzzy+embedding | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-02-24T00:03:27.927017+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
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Jeff Kavlick
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bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-02-24T18:03:55.078011+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
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2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
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—
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
—
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system with Nox to ensure compliance with NCPDP D.0 pharmacy claims format.
start_date
—
extracted_at
2026-02-26T00:03:45.483938+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-02-23T12:03:39.486758+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
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2025-08-13T03:04:30+00:00
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2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
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—
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bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-04-15T02:03:54.398141+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
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2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
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—
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using NCPDP D.0 format.
start_date
—
extracted_at
2026-02-19T06:03:53.112237+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system with Nox to ensure compliance with NCPDP D.0 pharmacy claim format.
start_date
—
extracted_at
2026-03-03T00:03:23.141935+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | 4cXGj2Ai3jbvDQ | CVS Payment and Eligibility Integration | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-03-22T02:03:44.674415+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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| moreland_contracts | PjeohaMkwyN2Ng | CVS Payment and Eligibility Integration | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
—
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-03-29T02:03:57.416781+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
|||||||
| moreland_contracts | xkAZ4S8S4WB+pg | CVS Payment and Eligibility Integration | 0.80 | fuzzy+embedding | Active |
|
|
|
Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
Nox
project_name
CVS Payment and Eligibility Integration
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system using the NCPDP D.0 format.
start_date
—
extracted_at
2026-03-30T02:04:35.925166+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
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| moreland_contracts | S+AzFnS4/ENhUw | Payment and Eligibility Integration with Nox | 0.80 | fuzzy+embedding | Active |
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Source Record
bronze_moreland_contracts_ma_project_contracts
file_hash
d3cca38c78e40b46d57b2b82e20122c6
file_name
2025-07 PBM Financial Partner Requirements.pdf
file_path
https://morelandpartners.sharepoint.com/sites/MorelandConnect-BusinessDevelopment/Shared%20Documents/Internal%20-%20Business%20Development/Nox%20Health/2025-07%20PBM%20Financial%20Partner%20Requirements.pdf
company
CVS
project_name
Payment and Eligibility Integration with Nox
contact_person
—
contract_type
fixed_fee
hourly_rate
—
estimated_hours
—
total_fee_estimate
—
brief_project_description
Integration of CVS's payment and eligibility information system with Nox to ensure compliance with NCPDP D.0 pharmacy claim format.
start_date
—
extracted_at
2026-02-23T18:03:59.277043+00:00
raw_text_preview
CVS Payment and Eligibility Integration ith Nox: What’s Required and
How It Works
1. The Big Picture
CVS wants all payment and eligibility information to be sent to them in a very specific
“pharmacy claims” format—not the format used for medical insurance billing.
The industry standard for this is called NCPDP D.0. Think of it as a set of strict instructions (an
API “language”) that tells CVS who you are, who the patient is, what medication or service we
are billing for, and what the outcome should be.
2. Core Requirements Explained
A. Company & Member Information
Company Info:
Who is submitting the claim? (This is our company’s ID numbers and credentials.)
Nox must send a unique ID, known as a NPI (National Provider Identifier), and a Software Certification ID tied to your system.
Member Info:
Who is the patient?
Details needed: patient’s name, date of birth, gender, full address, insurance card number (called the “Cardholder ID”), and
their relationship to the main policy holder (like spouse, child, self, etc.).
B. BIN/PCN and Group Information
BIN and PCN:
These are special numbers used by pharmacy benefit managers (like CVS Caremark) to know where to send the claim for
processing.
The BIN (Bank Identification Number) and PCN (Processor Control Number) are always required and can change based on
the patient’s plan.
Group ID:
This identifies the employer group or insurance plan the patient belongs to.
We get this from the patient’s insurance card.
C. UPC and NDC Codes (Drug/Service Details)
UPC Code:
Sometimes products or services have a Universal Product Code (UPC) instead of the usual drug code.
Nox must be able to “crosswalk” or convert a UPC code to an NDC (National Drug Code), which is what CVS uses to process
claims.
NDC Code:
Every drug has an NDC code that tells CVS exactly what’s being dispensed or billed.
D. Real-Time API Transactions
Eligibility Check:
When a patient registers, Nox needs to send an electronic request to CVS to see if their cove
file_created_at
2025-08-13T03:04:30+00:00
file_modified_at
2025-08-13T03:04:30+00:00
created_by
Jeff Kavlick
modified_by
Jeff Kavlick
_dlt_meta
—
|
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