• NPI

  • Effective May 23, 2008, all providers covered by HIPAA, including physicians, dentists, pharmacists, hospitals, nursing homes and medical groups who transmit health information electronically are required to use their National Provider Identifier (NPI) on electronic claims and other transactions. This applies to all 837 transactions, whether submitted through a clearinghouse or via direct submission.

    Affinity requires that a Billing NPI be present on your EDI claim. If claims and other electronic forms are submitted without a Billing Provider NPI, they will be rejected. When appropriate, a Rendering Provider NPI will be required if different than the Billing Provider NPI. We will also reject claims that contain non-matching NPI numbers to data in our provider files. Providers will then be required to correct and resubmit documents. Please refer to the technical specifications below for specific details on appropriate NPI data locations for electronic and paper claims submissions.

    Advise Affinity Health Plan of your NPI(s)

    If you have already obtained your NPI from the National Plan and Provider Enumeration System (NPPES) and have not yet advised Affinity, please provide us with this information. You may do so by contacting your provider relations representative or by completing the Provider Participation Form. Upon receipt of your NPI information, we will update our system within three business days. Also, be sure to advise your software vendor, billing service and/or clearinghouse of your NPI.

    How to apply for an NPI

    Healthcare providers can apply for their NPI online, by phone or mail

  • Pharmacy Grievances

  • A grievance is a complaint about any problem you had with Affinity or one of our network pharmacies. Grievances do not relate to payment for or approval of a prescription drug, which are known as coverage determinations.

    Contact Us Immediately

    If you (your appointed representative) have a grievance, please:

    • Call Customer Service:
      866.362.4002
      TTY: 711
    • Fax: 866.633.7673
    • Mail:
      CVS Caremark Inc
      Part D Services
      MC109
      P.O. Box 52000
      Phoenix, AZ 85072-2000

    Expedited Grievances

    If you are grieving the decision by Affinity not to expedite an initial determination or an appeal, you can request an expedited grievance. In these situations, Affinity will respond to you within 24 hours.