Coronavirus information: General information | Pharmacy FAQs

Resource - Pharmacy and provider

You’re the link between our members and their medicine. 
They count on you for the information they need
about their prescriptions.

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Your resources

Your resources

You can count on us to help you find the information you need:

  • A dedicated 24-hour pharmacy contact center
  • Ongoing communications about plan changes and additions
  • Regular news and updates on current pharmacy topics

Pharmacy providers

24-hour contact center


General (HCSC, MN, ND, NE) – 800.821.4795

Baptist Health Plan — 855.457.0006

Capital Health Plan – 866.469.5662 

Blue Cross and Blue Shield of Alabama – 800.216.9920

Florida Blue – 888.877.6323

Blue Cross and Blue Shield of Kansas – 877.893.8485

Blue Cross and Blue Shield of Montana – 866.590.3012

Horizon Blue Cross Blue Shield of New Jersey – 877.686.6875

Blue Cross and Blue Shield of North Carolina – 888.274.5186

Blue Cross and Blue Shield of Oklahoma – 877.353.0992

Blue Cross Blue Shield of Wyoming – 800.424.7094

Mississippi State and School Employees' Health Insurance – 855.457.0408

Medtronic – 855.457.0624

Medicare Part D

Alignment Health Plan — 855.457.0622

Capital Health Plan — 866.590.3010 

Arkansas Blue Cross and Blue Shield — 800.693.3815 

Blue Cross and Blue Shield of Alabama — 877.878.8668

Florida Blue — 888.877.6420

IL, MT, NM, TX > MAPD — 877.277.7898

IL, NM, OK, TX > MAPD, PDP — 800.693.6704

Illinois > MAPD.Special Needs Program, Dual Eligible Special Needs Program — 888.274.5246

Illinois > Medicare. Medicaid Alignment Initiative — 888.840.3068 

Blue Cross and Blue Shield of Minnesota > Secure Blue, Platinum Blue — 800.648.2778

Horizon Blue Cross Blue Shield of New Jersey — 800.391.1926

Horizon dSNP — 855.457.1347

BlueCross BlueShield of North Carolina— 877.277.7893

BlueCross BlueShield of South Carolina — 800.545.8512

Medicaid, Illinois > Family Health Plan — 855.457.0173

Medicaid, Illinois > Integrated Care Program — 888.274.5218

Medicaid, New Mexico — 888.840.3044

Medicaid TX STAR Kids Travis — 855.457.0757

Medicaid TX STAR Kids/MRSA Central (Medicaid Rural Service Area) — 855.457.0758

Nebraska MAPD — 855.457.1351

Vibra Health Plan — 855.457.1209

BlueCross BlueShield of Rhode Island — 855.457.1207

Electronic prior authorization

You can sign up to use the electronic prior authorization (ePA) system through CoverMyMeds, all that is needed is a computer, and an internet connection.

How to get started:

Visit to see if CoverMyMeds is already integrated with your pharmacy system, and start saving time today. 

If your pharmacy system is not integrated, please contact the pharmacy system directly to request an integration.


Pharmacy provider tools

Access Prime’s:

  • Prime’s maximum allowable cost (MAC) list | MAC Pricing
  • Specialty fee schedule(s)
  • Compound fee schedule
  • 835 health care electronic remittance advice
  • Electronic funds transfer (EFT)
  • Prime’s Credentialing Threshold

Log in | Sign up

Pharmacy credentialing

Use the link below to:

Pharmacy Credentialing

  • Complete a new Credentialing application
  • Complete a Re-Credentialing application
  • Submit updated insurance coverage information
  • Responding to a solicitation for a Credentialing application

Provider directory questionnaire

Use the link to:

  • Complete directory questionnaire to capture pharmacy URL
  • Confirm completion of cultural competency training
  • Submit whether the pharmacy offers American Sign Language

Directory questionnaire

Specialty Pharmacy Networks/Performance Guarantees

Each Pharmacy or Pharmacy Services Administration Organization (PSAO) participating in Prime’s Specialty Pharmacy Networks must adhere to requirements for reporting as outlined in Prime’s contractual reporting requirements, including but not limited to clinical reporting, performance guarantees and manufacture assistance reporting.  

If your pharmacy needs access to the reporting requirements or you have questions about contractual reporting requirements - please contact the Specialty Network Contracting team at:


Pharmacy claim processing

Vaccine program

Our national network allows participating pharmacies to submit a claim when administering vaccines.


Blue Cross & Blue Shield of Rhode Island Vaccine Processing Requirements

Prior authorization


Home infusion (HI)/Long-term care (LTC) validation

Each Pharmacy or Pharmacy Services Administration Organization (PSAO) participating in Prime’s HI and LTC networks must annually validate they are able to follow the guidelines outlined in Prime’s HI and/or LTC pharmacy networks.

Failure to validate may result in termination from Prime’s HI or LTC networks.

Long Term Care Validation 
Home Infusion Validation

Please note, if you are participating in both Prime's Long Term Care and Home Infusion networks, you need to complete both validation forms.

Compliance/Fraud, waste and abuse

Training and certification requirements

Every pharmacy in Prime’s network must do the following to meet compliance requirements:

Training: Provide CMS' "Medicare Parts C and D General Compliance (April 2020)" and "Medicare Fraud & Abuse: Prevent, Detect, and Report (February 2020)" training to each pharmacist and pharmacy staff member upon hire and annually thereafter. CMS training is available on the CMS website through their MLN Learning Management System (LMS).

Certification: Complete the FWA Certification form that is part of your pharmacy profile on NCPDP. Download instructions

Record keeping: Maintain internal training logs.

Policies and procedures: Maintain internal training protocols.

Prime’s Code of Conduct

Pharmacy audits

Report compliance, privacy, or fraud, waste and abuse concerns


Report suspected compliance concerns:



Report privacy concerns or potential protected health information (PHI) disclosures:


Fraud, waste and abuse

If you suspect fraud, waste or abuse (FWA) by a covered person, prescribing provider, participating pharmacy or anyone else, notify Prime at 800.731.3269 or

For suspected FWA involving the Federal Employee Plan, please notify: 


Anonymous reporting

Report a compliance concern or suspected fraud, waste or abuse anonymously, by contacting Prime’s 24-hour anonymous compliance hotline: