Explore pharmacist resources.

Capital Rx Provider Manual is a guide for network pharmacies that includes policies and procedures including, but not limited to, contact information, term definitions, claims processing information and pharmacy network participation requirements. Last updated: July 2021

Payer sheets provide data requirements needed to electronically process NCPDP pharmacy claims for each line of business within Capital RX. Each line of business will have a designated payer sheet for reference when setting up Capital Rx BIN/PCN numbers into the pharmacy system. Last updated: March 2022

Reversal Payer sheets provide data requirements needed to electronically process NCPDP pharmacy claim reversals for each line of business within Capital RX. Each line of business will have a designated reversal payer sheet for reference when a pharmacy chooses to reverse claims submitted to Capital RX from their pharmacy system. Last updated: October 2021

If you have questions regarding your pharmacy payments please reach out to ap@cap-rx.com.

If you have questions regarding your pharmacy remittance advice please outreach to ap@cap-rx.com

Please call us at (888) 832-2779 and our support team will work with you to validate the member’s eligibility.

To submit a prior authorization (if required) please complete the prior authorization request form and fax it (along with any additional documentation required) to (833) 434-0563. Prior authorization request forms can also be sent via mail to the below address: Capital Rx Attention Prior Authorization Department 228 Park Ave S Suite 87234 New York, New York 10003-1502