RxGroup values and field rules appear in the desktop group column. Hover over or expand a guidance label for instructions. On mobile, only specific group values are shown. An omitted group is not an instruction to leave the field blank. Use the current card, eligibility response or payer instructions. For Medicare Prescription Payment Plan participants, the paid primary response supplies the M3P BIN and PCN; see CMS final part one guidance, section 50.1 (February 2024).
Search published routes by BIN, RxBIN/RxIIN, PCN, payer, plan, state, or program. Results show the route details and dated public source; they do not replace the current card or eligibility response for a live claim.
Coverage in this edition: 413 source-linked route rows. Focused-guide imports include 135 Medicare, 143 Medicaid, 17 workers' compensation, and 7 discount-card rows. The remaining rows are maintained directly in this hub.
Specific RxGroup values are shown when available. Otherwise, check the current card or payer response. M3P billing guidance
No matching route in this directory. Clear the search or check the current card, eligibility response or payer document. A missing result does not mean a route is invalid.
| RX BIN or processor IIN | Published PCN examples | Processor or program | RxGroup | Published source |
|---|---|---|---|---|
| CVS Caremark | ||||
| 004336 | ADV, RXSADV, DCADV, WAL | Legacy ADV commercial routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 004336 | MEDDADV, 77993322 | Medicare Part D routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Medicare v2.0.7, Jan. 2026 |
| 020099 | AC, CH, WG, FC, WK, WP, IS, CS | Commercial client routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 020123 | IRXCOMM | Commercial client routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 021338 | ADV, RXSADV, DCADV | Commercial client routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 025201 | MOHMKP | Molina client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 026150 | SSRX50 | ScriptServ client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 027547 | SSRX42 | Named health-system route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 027555 | SSRX42 | Named health-system route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 027570 | SSRX42 | Named health-system route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 028406 | OSCAR | Oscar client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 028512 | SSRX42 | Named health-system route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 610239 | FEPRX | Federal Employee Program | RxGroup: 65006500 | Commercial v2.0.8 |
| 610415 | PCS, ADV | Legacy PCS routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 610502 | 00670000, AETCRXC | Aetna commercial routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial v2.0.8 |
| 610502 | MEDDAET, PARTBAET | Aetna Medicare Part D and Part B | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Medicare v2.0.7, Jan. 2026 |
| 610591 | MEDDADV | Medicare Part D routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Medicare v2.0.7, Jan. 2026 |
| 020388 | IRXMEDD, IRXMAON, IRXPARTB | Caremark Medicare Part D and Part B routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Medicare v2.0.7, Jan. 2026 |
| 028272 | MOHMCARE, MOHPARTB | Molina Medicare Part D and Part B routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Medicare v2.0.7, Jan. 2026 |
| OptumRx | ||||
| 001553 | TNM, CKDS | TennCare client routes | Payer instructionsCheck the linked source for RxGroup instructions. | Commercial and Medicaid 2026 |
| 011172 | SCCMS | Kaiser Southern California Medicare | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS July 2026 extract |
| 011214 | Regional PCN in source | Kaiser Medicare regional route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 011222 | Regional PCN in source | Kaiser Medicare regional route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 011230 | NWCMS | Kaiser Northwest Medicare | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS July 2026 extract |
| 011255 | COCMS | Kaiser Colorado Medicare | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS July 2026 extract |
| 011842 | NCCMS | Kaiser Northern California Medicare | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS July 2026 extract |
| 011859 | MACMSA | Kaiser Mid-Atlantic Medicare | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS July 2026 extract |
| 011933 | IAPOP | Iowa Medicaid client route | Payer instructionsCheck the linked source for RxGroup instructions. | Commercial and Medicaid 2026 |
| 013170 | Not required | Seniorscript Medicare route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Medicare 2026 |
| 014293 | WYOPOP | Wyoming Medicaid client route | Payer instructionsCheck the linked source for RxGroup instructions. | Commercial and Medicaid 2026 |
| 015789 | CTRXMEDD and named client PCNs | Medicare client routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 015855 | UTPOP | Utah Medicaid client route | Payer instructionsCheck the linked source for RxGroup instructions. | Commercial and Medicaid 2026 |
| 016580 | Not published | MedalistRx client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Commercial and Medicaid 2026 |
| 017522 | AC | Ascella client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| 019827 | HT | MedlessRx client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| 021692 | CTRXMEDD | BlueCross BlueShield of South Carolina Medicare | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 022485 | STL | CerpassRx client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| 023153 | HT | SavaScript client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| 025771 | RX42AS | BlueCross BlueShield of South Carolina route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| 025796 | Varies by client | CareCard routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| 220026 | EMRXMA | BCBS Michigan Emergient Medicare route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 262400 | RXBCMA | BCBS Michigan SHS Medicare route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 610011 | Varies by named client | Commercial and Medicare client routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 610097 | 9999, 7777 | Part D and MAPD routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 610097 | 8888, 8500 | Part D wrap routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 610127 | 04000001, 04000002, and other wrap PCNs | Commercial coordination-of-benefits routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | COB payer sheet 2026 |
| 610279 | 9999, CONTRAC, 7777 | UHC employer, contraceptive-only, and exchange routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | UHC 610279 sheet 2026 |
| 610494 | 9999, 2417, and state client PCNs | Commercial and Medicaid routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| 610494 | 2222 | UnitedHealthcare government programs | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 610593 | HNEMEDD, SXCFLH | Medicare client routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Medicare 2026 |
| 610613 | 2417 | Community Health client route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| 610652 | Varies by plan | AARP client routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial and Medicaid 2026 |
| Prime Therapeutics | ||||
| 004915 | Not required, WRI, CPAL | BCBS Alabama and named commercial routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial sheet, Dec. 2025 |
| 610455 | KSBCS, BCBSKS, LGHIBRX, SEIBRX, NY1000 | Kansas and EmblemHealth commercial routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Commercial sheet, Dec. 2025 |
| 610455 | NY4000, NY4020 | EmblemHealth Medicare and prescription carveout routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Prime Perspective, Dec. 2025 |
| Additional PBMs and processors | ||||
| 610602 | From card; NVTD, MCD, and NVT examples | Navitus commercial, Medicare, and Medicaid client routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Navitus manual v202601 |
| 012312 | PARTD | MedImpact-administered route used by multiple current Part D sponsors | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS July 2026 extract |
| 015574 | ASPROD1 | MedImpact Part D route in current CMS plan records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | CMS 2026 BIN/PCN file |
| 020040 | Multiple client PCNs | MedImpact route for legacy Archimedes clients | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Legacy Elixir sheet, Apr. 2025 |
| 020594 | Multiple client PCNs | MedImpact route for legacy Archimedes clients | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Legacy Elixir sheet, Apr. 2025 |
| 023491 | Multiple client PCNs | MedImpact route for legacy Archimedes clients | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Legacy Elixir sheet, Apr. 2025 |
| 610852 | CHM or client-specific | Judi Rx, formerly Capital Rx, commercial routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Judi Rx pharmacist resources |
| 610770 | CAPLRX or client-specific | Judi Rx commercial routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Judi Rx pharmacist resources |
| 610770 | CRXMD | Judi Rx Medicare route in current CMS plan records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | CMS 2026 BIN/PCN file |
| 610674 | Client-specific; abarcaD Medicare example | Abarca commercial, Medicaid, and Medicare routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. The linked payer source marks the group as required. | Abarca provider manual |
| Current independent PBM payer sheets | ||||
| 015433 | SSN | Liviniti commercial pharmacy claims | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Liviniti pharmacy manual, Mar. 2026 |
| 021882 | 201907 | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 019025 | 8001002, 5289 | SmithRx routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 024368 | 3207, 3208, 3210, 3211, 3212, or plan-specific | SmithRx routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 023211 | WMHRX | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 024789 | WMHRX | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 028017 | 4001 | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 028025 | 4002 | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 028363 | 4003 | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 028371 | 4004 | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 028389 | 4005 | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 028397 | 4006 | SmithRx route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | SmithRx payer sheet, Oct. 2025 |
| 008878 | WDRX, NETCARD, TCN, UFCW, or card-specific | WellDyne commercial routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 015723 | TRIADCR | WellDyne Triad Care | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 019173 | Not required | WellDyne Eagle Pharmacy / Knipper Health | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 015962 | PDC | WellDyne Palliative Drug Care Rx | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 024433 | Card-specific | WellDyne PDCRxMX / Medalist Rx | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 024441 | Card-specific | WellDyne PDCRx | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 025036 | ORX26; verify directly | WellDyne OrchestraRx: source conflict | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 025219 | WDBRx | WellDyne BESTRx | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 025359 | SELECT | WellDyne Select | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 025961 | SRXLB, SELECTRX | WellDyne SelectRx limited-benefit routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| 026142 | SSRX42 | WellDyne Children’s Nebraska / ScriptServ | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne payer sheet, May 2026 |
| Medicare and federal program routes | ||||
| 610097 | 9999 | OptumRx Part D and Medicare Advantage prescription drug records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 015581 | 03200000 | Broadly reused Part D route; group and member ID remain plan-specific | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610502 | MEDDAET | Aetna Medicare processing through CVS Caremark | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 004336 | MEDDADV | CVS Caremark Medicare Part D records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610014 | MEDDPRIME | Express Scripts-administered route reused by Wellcare, Express Scripts Medicare, Highmark, and other sponsors | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 020115 | IS | CVS Caremark Medicare route used by multiple sponsors | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 017010 | CIMCARE | Cigna Medicare prescription drug records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 003858 | MD | Express Scripts-administered route used by multiple Medicare sponsors | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610011 | CTRXMEDD | OptumRx Medicare client records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 015574 | ASPROD1 | MedImpact-administered route used by multiple Part D sponsors | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610602 | NVTD | Navitus-administered route used by Geisinger, Moda, and other sponsors | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 012312 | PARTD | MedImpact-administered route used by MCS, Astiva, and other sponsors | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610455 | AHPPARTD | Alignment Health Plan Medicare route processed by Prime Therapeutics | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 611791 | CARELONRX | CarelonRx Part D records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610674 | abarcaD | Abarca Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 015581 | 03200008 | CarePlus Medicare plans; do not substitute for the more widely reused 03200000 route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 026696 | 77993322 | Blue Shield of California Medicare plans | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610770 | CRXMD | Judi Rx, formerly Capital Rx, Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 012635 | NA | Independent Health and Pharmacy Benefit Dimensions Medicare plans | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610674 | PHPMEDDRX | Prominence Health Plan Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 012833 | MedDPrime | Florida Blue and BlueMedicare records; preserve the PCN casing returned by the card or E1 response | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 015938 | 7463 | Select Health Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 011859 | MACMSA | Kaiser Permanente Mid-Atlantic Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610455 | SOMAPD | Solis Health Plans Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 011842 | NCCMS | Kaiser Permanente Northern California Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 020388 | IRXMEDD | CVS Caremark-administered Medicare Part D route used by multiple sponsors | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 011172 | SCCMS | Kaiser Permanente Southern California Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610455 | NY4000 | EmblemHealth Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 014897 | MBG | Blue Cross and Blue Shield of Alabama Blue Advantage records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 021692 | CTRXMEDD | BlueCross BlueShield of South Carolina Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610455 | EMNH5959 | Blue Cross and Blue Shield of Minnesota Medicare Advantage records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 011255 | COCMS | Kaiser Permanente Colorado Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 015905 | HMONC | Blue Cross and Blue Shield of North Carolina Blue Medicare HMO records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610602 | EGWP | Navitus MedicareRx employer group records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 011230 | NWCMS | Kaiser Permanente Northwest Medicare records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 610455 | KSPDP | Blue Cross and Blue Shield of Kansas Blue MedicareRx PDP records | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | CMS 2026 extract |
| 004336 | ADV | Legacy ADV Part B route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Caremark Medicare v2.0.7 |
| 004336 | PARTBADV | Legacy ADV Part B route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Caremark Medicare v2.0.7 |
| 610502 | PARTBAET | Aetna Part B route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Caremark Medicare v2.0.7 |
| 020115 | NS | Caremark-published Part B route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Caremark Medicare v2.0.7 |
| 020388 | IRXMAON | Caremark-published Part B route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Caremark Medicare v2.0.7 |
| 020388 | IRXPARTB | Caremark-published Part B route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Caremark Medicare v2.0.7 |
| 028272 | MOHPARTB | Molina Part B route effective January 1, 2026 | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Caremark Medicare v2.0.7 |
| 004336 | 77993355 | Caremark-published Part B route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | Caremark Medicare v2.0.7 |
| 0022188 | PSTMEDD | PACE records across many organizations; this is a seven-character processor ID or IIN | Card / eligibilityUse the RxGroup from the participant's current PACE card or E1 response. | CMS July 2026 extract |
| 024748 | GRNMEDD | PACE records across multiple organizations | Card / eligibilityUse the RxGroup from the participant's current PACE card or E1 response. | CMS July 2026 extract |
| 016110 | PACE | PACE records across multiple organizations | Card / eligibilityUse the RxGroup from the participant's current PACE card or E1 response. | CMS July 2026 extract |
| 610097 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610649 | MPPP7777 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610502 | MPPPOR | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 004336 | MPPPOR | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610014 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 020115 | MPPPOR | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 017010 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 003858 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610011 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 027133 | MPPPPROD1 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 011552 | MPPPHCSC | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 027100 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPPARTD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 012312 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 611791 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610674 | MPPPTSSADV | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPCAP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610649 | MPPP8888 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 011842 | MPPPNC | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 012833 | MPPPFL | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 024896 | MPPP65 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 026696 | MPPP3322 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610674 | MPPPPROD1 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 011859 | MPPPMA | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610623 | MPPP021000 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610770 | MPPPCRX | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 027357 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPSO | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 004336 | MPPOR | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 011255 | MPPPCO | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 011172 | MPPPSC | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 0022188 | PSTMEDD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 020388 | MPPPOR | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610011 | MPPPWA | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPPARTDG | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 016499 | MPPPNJ | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 600428 | MPPP0299 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 015905 | MPPPNC | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPRI | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 021692 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPMN | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 004336 | MEDDADV | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 011214 | MPPPHI | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 011222 | MPPPGA | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPKS | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPMAPD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610953 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPNE | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 011230 | MPPPNW | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 024748 | GRNMEDD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPHCSC | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 014897 | MPPPMBG | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 024756 | ASCHMEDD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPCHP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPCS | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610623 | MPPP021100 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 014897 | MPPPPLX | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 027133 | MPPPPROD01 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPCHPG | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPPB | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610593 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610623 | MPPP021200 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 014897 | MPPPRD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 015574 | ASPROD1 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 015574 | MPPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 019439 | MPPP3000 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 019439 | MPPP3841 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 019587 | MPPP0619 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 019587 | MPPP11802 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 020289 | MPPPEH | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 022118 | PSTMEDD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610011 | CTRXMEDD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPPDP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610591 | MPPPPOR | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 0022188 | PSTNEDD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 012312 | MPPPE1 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 012312 | PARTD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 015905 | MPPPNCS | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 017010 | MPP | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 019587 | MPPP11819 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 019587 | MPPP11820 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 027133 | MPPPPROD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 027174 | MPPPRXA | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 600428 | MPPP0333 | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPGCMAPD | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610455 | MPPPSB | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 610591 | MPPPOR | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 611139 | MPPPOR | Medicare Prescription Payment Plan COB route | Primary responseFor an enrolled Medicare Prescription Payment Plan participant, the paid primary Part D response supplies the M3P BIN and PCN. This is routing guidance, not a published RxGroup value. Follow the plan's returned billing instructions. | CMS July 2026 extract |
| 003858 | A4 | TRICARE pharmacy program | RxGroup: DODA | TRICARE FAQ, Oct. 2024 |
| 015599 | 05440000 | Medicare LI NET | May be blankThe linked source permits a blank RxGroup in the circumstances it describes. Check those conditions before billing. | CMS LI NET resources |
| 028918 | MEDDGLP1BR | Medicare GLP-1 Bridge, effective July 2026 | Payer instructionsRxGroup is program-specific. Check the current program instructions. | CMS pharmacy instructions, July 2026 |
| State Medicaid fee-for-service and managed-care routes | ||||
| 004146 | Not used | Alabama Medicaid FFS | Not usedThe linked source identifies RxGroup as not used for this route. | Alabama NCPDP companion guide, May 2026 |
| 001553 | AZM | Arizona AHCCCS FFS | BlankThe linked source specifies a blank RxGroup for this route. | 2026 AHCCCS route table |
| 017606 | P027017606 | Arkansas Medicaid FFS | RxGroup: ARMEDICAID | Arkansas pharmacy document library |
| 022659 | 6334225 | California Medi-Cal Rx | RxGroup: MediCalRx | August 21, 2026 payer specification |
| 018902 | P303018902 | Colorado Medicaid FFS | RxGroup: COMEDICAID | Colorado Medicaid payer sheet, effective April 2026 |
| 018407 | DCMC018407 | District of Columbia FFS and Alliance | RxGroup: Alliance ICP | D.C. Transmittal 25-22 |
| 013352 | P035013352 | Florida Medicaid FFS | RxGroup: FLMEDICAID | Florida NCPDP payer specification |
| 001553 | GAM | Georgia Medicaid FFS | Not requiredThe linked source identifies RxGroup as not required for this route. | Georgia FFS payer sheet |
| 610084 | DRHIPROD | Hawaii Med-QUEST FFS | RxGroup: HAWAII1000; HAWAII2000 for OYS | Hawaii Medicaid payer sheet |
| 014864 | P043014864 | Idaho Medicaid FFS | RxGroup: IDMEDICAID | Idaho claims manual |
| 017804 | ILPOP | Illinois Medicaid FFS, ILPOP | BlankThe linked source specifies a blank RxGroup for this route. | Illinois payer sheet |
| 001553 | INM | Indiana Medicaid FFS | Not publishedThis source does not publish a specific RxGroup. Confirm the current card or payer instructions; this does not mean the field should be blank. | Indiana pharmacy services |
| 011933 | IAPOP | Iowa Medicaid FFS | BlankThe linked source specifies a blank RxGroup for this route. | Iowa payer sheet |
| 610517 | Blank | Kansas Medicaid FFS | BlankThe linked source specifies a blank RxGroup for this route. | Kansas FFS and MCO billing page |
| 026309 | KYPROD1 | Kentucky Medicaid FFS | RxGroup: KYF01 | Kentucky route table |
| 610514 | LOUIPROD | Louisiana Medicaid FFS | BlankThe linked source specifies a blank RxGroup for this route. | Louisiana Informational Bulletin 25-27 |
| 005526 | MEPOP | MaineCare FFS | BlankThe linked source specifies a blank RxGroup for this route. | April 2026 MaineCare provider newsletter |
| 610084 | DRMDPROD | Maryland Medicaid FFS | RxGroup: MDMEDICAID | Maryland state route notice |
| 009555 | MASSPROD | MassHealth FFS and PCC | RxGroup: MassHealth | MassHealth Pharmacy Facts 264 |
| 009737 | P008009737 | Michigan Medicaid FFS | RxGroup: MIMEDICAID | Michigan pharmacy benefit page |
| 026787 | 5309662024 | Minnesota state-administered pharmacy | BlankThe linked source specifies a blank RxGroup for this route. | Minnesota payer specification |
| 025151 | DRMSPROD | Mississippi Medicaid | BlankThe linked source specifies a blank RxGroup for this route. | Mississippi Medicaid pharmacy |
| 004047 | 43-1754897 | MO HealthNet FFS | BlankThe linked source specifies a blank RxGroup for this route. | MO HealthNet payer sheets |
| 610084 | DRMTPROD | Montana Medicaid FFS | RxGroup: 1509040; 0064206420 for MHSP | Montana payer sheet |
| 013766 | P063013766 | Nebraska Medicaid FFS | RxGroup: NEBMEDICAID | Nebraska payer specification |
| 024888 | 683377 | Nevada Medicaid FFS | RxGroup: NVMEDICAID | Nevada pharmacy provider FAQ |
| 009513 | P002002286 | New Hampshire Medicaid FFS | RxGroup: ALL | New Hampshire provider notice |
| 610515 | SUPP NJ | New Jersey Medicaid FFS | Not usedThe linked source identifies RxGroup as not used for this route. | New Jersey pharmacy training Q&A |
| 028165 | DRNMPROD | New Mexico Medicaid FFS | Payer instructionsCheck the linked payer sheet for RxGroup instructions. | New Mexico FFS payer sheet |
| 004740 | Pharmacy-specific ETIN/PIN | New York Medicaid NYRx | Not usedThe linked source identifies RxGroup as not used for this route. | NYRx provider guidance |
| 610242 | 781640064 | North Carolina Medicaid Direct | BlankThe linked source specifies a blank RxGroup for this route. | North Carolina pharmacy services |
| 601364 | DRNDPROD | North Dakota Medicaid FFS | RxGroup: NDMEDIFFS | North Dakota payer sheet |
| 024251 | OHRXPFFS | Ohio Medicaid FFS | BlankThe linked source specifies a blank RxGroup for this route. | Ohio SPBM FFS vendor specification v4.1, June 2026 |
| 010579 | OKA01 | Oklahoma SoonerCare | RxGroup: Pharmacy's 10-digit pay-to NPI | Oklahoma NCPDP payer sheet |
| 014203 | ORDHSFFS | Oregon Health Authority open card | BlankThe linked source specifies a blank RxGroup for this route. | Oregon pharmacy quick reference |
| 600760 | Not applicable | Pennsylvania Medicaid FFS | Not applicableThe linked source identifies RxGroup as not applicable for this route. | Pennsylvania pharmacy guidance |
| 610471 | MCAID1293 | Rhode Island Medicaid FFS | Not publishedThis source does not publish a specific RxGroup. Confirm the current card or payer instructions; this does not mean the field should be blank. | Rhode Island provider update |
| 009745 | P006009745 | South Carolina Medicaid FFS | RxGroup: SCMedicaid or SOC01 | South Carolina pharmacy provider portal |
| 601574 | Blank | South Dakota Medicaid FFS | BlankThe linked source specifies a blank RxGroup for this route. | South Dakota payer sheet |
| 001553 | TNM | Tennessee TennCare | Not applicableThe linked source identifies RxGroup as not applicable for this route. | TennCare pharmacy provider portal |
| 610084 | DRTXPROD | Texas Medicaid non-managed care | RxGroup: MEDICAID | Sample Your Texas Benefits card |
| 015855 | UTPOP | Utah Medicaid FFS | BlankThe linked source specifies a blank RxGroup for this route. | Utah NCPDP payer sheet |
| 017795 | VTPOP | Vermont Medicaid | Payer instructionsCheck the linked program rules for RxGroup instructions. | Vermont pharmacy provider manual |
| 010900 | 8263342243 | Virginia Medicaid FFS | RxGroup: VAMEDICAID | Virginia NCPDP payer sheet |
| 024822 | DRWAPROD | Washington Apple Health FFS | RxGroup: CAID | Washington plan billing information |
| 610164 | DRWVPROD | West Virginia Medicaid | BlankThe linked source specifies a blank RxGroup for this route. | West Virginia pharmacy services |
| 610499 | Program-specific or blank | Wisconsin Medicaid and BadgerCare Plus | RxGroup: TXIX | ForwardHealth pharmacy claim specification |
| 014293 | WYOPOP | Wyoming Medicaid FFS | BlankThe linked source specifies a blank RxGroup for this route. | Wyoming pharmacy services manual |
| 610494 | 4100 | Arizona · UnitedHealthcare Community Plan (Acute, CRS, DD and LTC) | RxGroup: ACUAZ | AHCCCS route table |
| 003858 | MA | Arizona · Care1st | RxGroup: 2DVA | AHCCCS route table |
| 610591 | ADV | Arizona · Mercy Care DCS CHP, ACC, DD and LTC | RxGroup: RX8805 | AHCCCS route table |
| 001553 | AZMDDD | Arizona · Division of Developmental Disabilities FFS | BlankThe linked source specifies a blank RxGroup for this route. | AHCCCS route table |
| 004336 | MCAIDADV | Arizona · BCBAZ Health Choice Arizona | RxGroup: RX3898 | AHCCCS route table |
| 003858 | MA | Arizona · Arizona Complete Health | RxGroup: 2DZA | AHCCCS route table |
| 004336 | MCAIDADV | Arizona · Molina Healthcare | RxGroup: RX21EJ | AHCCCS route table |
| 004336 | MCAIDADV | Arizona · Molina KidsCare | RxGroup: RX21BE | AHCCCS route table |
| 004336 | MCAIDADV | Arizona · Molina Dual Eligible Plan | RxGroup: RX51BI | AHCCCS route table |
| 610014 | MA | Arizona · Banner University Family Care | RxGroup: BANBUHP | AHCCCS route table |
| 003858 | MA | Arizona · Banner University Family Care (alternate published BIN) | RxGroup: BANBUHP | AHCCCS route table |
| 610591 | ADV | Arizona · Mercy Care RBHA | RxGroup: RX8822 | AHCCCS route table |
| 020107 | IN | Indiana · Anthem | RxGroup: WKXA | Indiana pharmacy services |
| 003858 | MA | Indiana · CareSource | RxGroup: RXINN01 | Indiana pharmacy services |
| 610649 | 03191506 | Indiana · Humana PathWays | RxGroup: 28968 | Indiana pharmacy services |
| 003858 | MA | Indiana · MHS | RxGroup: 2EKA | Indiana pharmacy services |
| 610494 | 4841 | Indiana · UnitedHealthcare | RxGroup: ACUIN | Indiana pharmacy services |
| 020107 | IRXKS | Kansas · Healthy Blue Kansas | RxGroup: RX8481 | KanCare billing codes |
| 003858 | MA | Kansas · Sunflower Health Plan | RxGroup: 2ELA | KanCare billing codes |
| 610494 | 9999 | Kansas · UnitedHealthcare Community Plan | RxGroup: ACUKS | KanCare billing codes |
| 610591 | MCAIDADV | Louisiana · Aetna Better Health | RxGroup: RX881J | Louisiana pharmacy billing table |
| 019595 | 06030000 | Louisiana · AmeriHealth Caritas | BlankThe linked source specifies a blank RxGroup for this route. | Louisiana pharmacy billing table |
| 020107 | LA | Louisiana · Healthy Blue | RxGroup: RX8482 | Louisiana pharmacy billing table |
| 610649 | 03191502 | Louisiana · Humana Healthy Horizons | RxGroup: LAM01 | Louisiana pharmacy billing table |
| 003858 | MA | Louisiana · Louisiana Healthcare Connections | RxGroup: 2ENA | Louisiana pharmacy billing table |
| 610011 | IRX | Massachusetts · Fallon Health–Atrius, Berkshire Fallon, and Fallon 365 Care | RxGroup: FCHPMCD | MassHealth Pharmacy Facts 264 |
| 610593 | MHP | Massachusetts · Be Healthy Partnership Plan (HNE) | RxGroup: HNEMH | MassHealth Pharmacy Facts 264 |
| 610011 | ORX | Massachusetts · Mass General Brigham Health Plan with Mass General Brigham ACO | RxGroup: RX1653 | MassHealth Pharmacy Facts 264 |
| 610011 | IRX | Massachusetts · Tufts Health Together with CHA and UMass Memorial Health | RxGroup: RXMCDMA | MassHealth Pharmacy Facts 264 |
| 003858 | MA | Massachusetts · WellSense ACO partnerships and Essential MCO | RxGroup: MAHLTH | MassHealth Pharmacy Facts 264 |
| 610591 | ADV | Michigan · Aetna Better Health | RxGroup: RX8826 | Michigan health-plan route table |
| 019595 | PRX00621 | Michigan · Blue Cross Complete | BlankThe linked source specifies a blank RxGroup for this route. | Michigan health-plan route table |
| 003858 | MA | Michigan · HAP CareSource | RxGroup: CSHAPMI | Michigan health-plan route table |
| 017142 | ASPROD1 | Michigan · McLaren Health Plan | RxGroup: ML108; ML110; ML284; ML329 | Michigan health-plan route table |
| 003858 | MA | Michigan · Meridian Health Plan | RxGroup: 2EPA | Michigan health-plan route table |
| 004336 | MCAIDADV | Michigan · Molina Healthcare | RxGroup: RX0506 | Michigan health-plan route table |
| 003858 | MA | Michigan · Priority Health Choice | RxGroup: PHMEDCD | Michigan health-plan route table |
| 610494 | 4242 | Michigan · UnitedHealthcare Community Plan | RxGroup: ACUMI | Michigan health-plan route table |
| 003858 | MA | Michigan · Upper Peninsula Health Plan | RxGroup: UPHPMDC | Michigan health-plan route table |
| 019595 | PRX00801 | North Carolina · AmeriHealth Caritas | BlankThe linked source specifies a blank RxGroup for this route. | North Carolina pharmacy services |
| 020107 | NC | North Carolina · Healthy Blue and Healthy Blue Care Together | RxGroup: 8473 | North Carolina pharmacy services |
| 003858 | MA | North Carolina · Carolina Complete Health | RxGroup: 2ERA | North Carolina pharmacy services |
| 610494 | 4949 | North Carolina · UnitedHealthcare | RxGroup: ACUNC | North Carolina pharmacy services |
| 610602 | MCD | North Carolina · Alliance tailored plan | RxGroup: TPMC | North Carolina pharmacy services |
| 025052 | MCAIDADV | North Carolina · Partners tailored plan | RxGroup: RX22AC | North Carolina pharmacy services |
| 019595 | PRX10811 | North Carolina · Trillium tailored plan | BlankThe linked source specifies a blank RxGroup for this route. | North Carolina pharmacy services |
| 610602 | MCD | North Carolina · Vaya tailored plan | RxGroup: VAYARX | North Carolina pharmacy services |
| 024251 | OHRXPROD | Ohio · AmeriHealth, Anthem, Buckeye, CareSource, Humana, Molina and UnitedHealthcare | BlankThe linked source specifies a blank RxGroup for this route. | Ohio managed-care route guide |
| 003585 | 38900 | Oregon · Advanced Health | BlankThe linked source specifies a blank RxGroup for this route. | Oregon pharmacy quick reference |
| 003585 | 38060 | Oregon · AllCare | BlankThe linked source specifies a blank RxGroup for this route. | Oregon pharmacy quick reference |
| 003585 | 38960 | Oregon · Cascade Health Alliance | BlankThe linked source specifies a blank RxGroup for this route. | Oregon pharmacy quick reference |
| 610011 | IRX | Oregon · Columbia Pacific, Health Share–CareOregon and Jackson Care Connect | RxGroup: CORMCAID | Oregon pharmacy quick reference |
| 610602 | MCD | Oregon · Eastern Oregon CCO | RxGroup: 10009552 | Oregon pharmacy quick reference |
| 003585 | 70000 | Oregon · Health Share–Kaiser Permanente | RxGroup: KP007 | Oregon pharmacy quick reference |
| 004336 | ADV | Oregon · Health Share–Legacy/PacificSource and PacificSource Community Solutions | RxGroup: RX6156 | Oregon pharmacy quick reference |
| 017142 | ASPROD1 | Oregon · Health Share–OHSU Health | RxGroup: OHU01 | Oregon pharmacy quick reference |
| 600428 | 07870000 | Oregon · Health Share–Providence | RxGroup: 100598 | Oregon pharmacy quick reference |
| 610011 | IRX | Oregon · InterCommunity Health Network | RxGroup: SAMCAID | Oregon pharmacy quick reference |
| 610602 | NVT | Oregon · Moda Health OHP Dental (COFA and Veteran Dental) | RxGroup: COFAV | Oregon pharmacy quick reference |
| 003858 | MA | Oregon · Trillium Lane and Tri-County | RxGroup: 2EZA | Oregon pharmacy quick reference |
| 003585 | 38920 | Oregon · Umpqua Health Alliance | RxGroup: 38920 | Oregon pharmacy quick reference |
| 600428 | 07870000 | Oregon · Yamhill Community Care | RxGroup: YCCOPHTK | Oregon pharmacy quick reference |
| 019595 | 01940000 | Pennsylvania · AmeriHealth Caritas Pennsylvania and Keystone First | BlankThe linked source specifies a blank RxGroup for this route. | Pennsylvania FFS/MCO table |
| 019595 | 07630000 | Pennsylvania · AmeriHealth and Keystone First Community HealthChoices | BlankThe linked source specifies a blank RxGroup for this route. | Pennsylvania FFS/MCO table |
| 026010 | MCDG | Pennsylvania · Geisinger Health Plan | BlankThe linked source specifies a blank RxGroup for this route. | Pennsylvania FFS/MCO table |
| 004336 | MCAIDADV | Pennsylvania · Health Partners of Philadelphia | RxGroup: RX3892 | Pennsylvania FFS/MCO table |
| 004336 | MCAIDADV | Pennsylvania · Highmark Wholecare (Medicaid primary) | RxGroup: RX2338 | Pennsylvania FFS/MCO table |
| 003858 | MA | Pennsylvania · Pennsylvania Health & Wellness | RxGroup: 2FBA | Pennsylvania FFS/MCO table |
| 610494 | 4200 | Pennsylvania · UnitedHealthcare Community Plan | RxGroup: ACUPA | Pennsylvania FFS/MCO table |
| 003858 | A4 | Pennsylvania · UPMC for You | RxGroup: PMDM | Pennsylvania FFS/MCO table |
| 610591 | ADV | Virginia · Aetna | RxGroup: RX8837 | Virginia health-plan route table |
| 020107 | FM | Virginia · Anthem | RxGroup: WQVVA | Virginia health-plan route table |
| 610649 | 03191507 | Virginia · Humana | RxGroup: VAM01 | Virginia health-plan route table |
| 003858 | MA | Virginia · Sentara | RxGroup: OHPMDCD; VPMMDCD; SHPMDCD | Virginia health-plan route table |
| 610494 | 4900 | Virginia · UnitedHealthcare | RxGroup: ACUVA | Virginia health-plan route table |
| 003858 | A4 | Washington · Community Health Plan of Washington | RxGroup: L57A | Apple Health billing table |
| 003858 | A4 | Washington · Community Health Plan, Apple Health Expansion | RxGroup: AH2 | Apple Health billing table |
| 003858 | MA | Washington · Coordinated Care | RxGroup: 2FEA | Apple Health billing table |
| 003858 | APHE | Washington · Coordinated Care, Apple Health Expansion | RxGroup: AP2FEA | Apple Health billing table |
| 004336 | MCAIDADV | Washington · Molina Apple Health Integrated Managed Care | RxGroup: RX0540; RX0542; RX0543; RX0828; RX0574 | Apple Health billing table |
| 004336 | MCAIDWA | Washington · Molina Apple Health Expansion | RxGroup: RX51BP | Apple Health billing table |
| 610494 | 4600 | Washington · UnitedHealthcare Apple Health Integrated Managed Care | RxGroup: ACUWA | Apple Health billing table |
| 610494 | 4600 | Washington · UnitedHealthcare Apple Health Expansion | RxGroup: ACUWAAPL | Apple Health billing table |
| 020107 | CM | Washington · Wellpoint | RxGroup: WKHA | Apple Health billing table |
| 020107 | IRXCOBOPPR | Kansas · Healthy Blue secondary to Medicare Part D | RxGroup: RX8481 | KanCare billing codes |
| 020107 | IRXCOBOPAP | Kansas · Healthy Blue secondary to commercial coverage | RxGroup: RX8481 | KanCare billing codes |
| 003858 | KSMEDD | Kansas · Sunflower secondary to Medicare Part D | RxGroup: 2ELA | KanCare billing codes |
| 610494 | 4848 | Kansas · UnitedHealthcare secondary to Medicare Part D | RxGroup: ACUKS | KanCare billing codes |
| 610097 | 9999 | Kansas · UnitedHealthcare Dual Complete H0169-004 | RxGroup: MPDCSP | KanCare billing codes |
| 610097 | 9999 | Kansas · UnitedHealthcare Dual Complete H5322-029 | RxGroup: MPDCSKS | KanCare billing codes |
| 610517 | MEDD | Kansas · FFS Medicare Part D copay assistance, COB scenario 2 | BlankThe linked source specifies a blank RxGroup for this route. | KanCare billing codes |
| 012114 | MCAIDADV | Pennsylvania · Highmark Wholecare secondary to Medicare | RxGroup: RX2338 | Pennsylvania FFS/MCO table |
| 013089 | MCAIDADV | Pennsylvania · Highmark Wholecare secondary to commercial insurance | RxGroup: RX2338 | Pennsylvania FFS/MCO table |
| 012114 | COBADV | Washington · Molina secondary to Medicare Part D | RxGroup: RX0540; RX0542; RX0543; RX0828; RX0574 | Apple Health billing table |
| 013089 | COMADV | Washington · Molina secondary to commercial coverage | RxGroup: RX0540; RX0542; RX0543; RX0828; RX0574 | Apple Health billing table |
| Workers' compensation and first-fill routes | ||||
| 610566 | Blank | Washington L&I State Fund | Not usedThe linked source identifies RxGroup as not used for this route. | Washington L&I payer sheet |
| 014658 | WSI | North Dakota WSI, LucyRx | RxGroup: 8001 | North Dakota WSI pharmacy services |
| 024004 | NVTWC | Oregon SAIF, Navitus | RxGroup: SAIF | SAIF medication instructions |
| 610235 | WRK | New York State Insurance Fund, CVS Caremark | RxGroup: NYSIF | NYSIF claimant guide and temporary form |
| 610084 | DRWDPROD | U.S. DOL DCMWC and DEEOIC, Conduent | Payer instructionsRxGroup depends on the authorization. Use the group supplied for that authorization. | DOL OWCP pharmacy portal |
| 004261 | CAL | Optum Tmesys, direct route | Payer instructionsRxGroup is client-specific. Check the current payer instructions or member card. | OptumRx pharmacy provider manual |
| 002538 | CAL | Optum Tmesys, Envoy route | Payer instructionsRxGroup is client-specific. Check the current payer instructions or member card. | OptumRx pharmacy provider manual |
| 004261 | CAL | Texas Mutual, Optum Tmesys | RxGroup: TXSMFF | Texas Mutual first-fill form |
| 003858 | WC | California State Fund, myMatrixx | RxGroup: CSCIF | California State Fund temporary card |
| 003858 | WC | Montana State Fund, myMatrixx | RxGroup: K9JA | Current Montana State Fund first-fill page |
| 019082 | MPS | KEMI, ScriptAdvisor | RxGroup: MPS001591TC | KEMI first-fill form |
| 023377 | MPS | CNA, ScriptAdvisor | RxGroup: 001731TC | CNA first-fill form |
| 003858 | WC | Chesapeake Employers or IWIF, myMatrixx | RxGroup: IWIF | Chesapeake first-fill page |
| 003858 | WC | Workers' Compensation Trust, myMatrixx | RxGroup: ESR3050 | WC Trust first-fill page |
| 003858 | WC | Universal Risk Services, myMatrixx | RxGroup: 77NA | Universal Risk first-fill page |
| 003858 | WC | Third Coast Underwriters, myMatrixx | RxGroup: KQTA | AF Group first-fill form |
| 004336 | ADV | CorVel, MEMIC named 2026 form | RxGroup: RXFFWC8757788 | MEMIC CorVel first-fill form |
| Prescription discount-card examples | ||||
| 019520 | NMeds | NeedyMeds standard card | RxGroup: DRUGCARD | Current NeedyMeds card |
| 006053 | MSC | ScriptSave WellRx | RxGroup: 8602 | Current WellRx coupon example |
| 019363 | 7283 | Inside Rx, people | RxGroup: SVECARD | Inside Rx card data |
| 019363 | 7283 | Inside Rx, pets | RxGroup: SVECD99 | Inside Rx card data |
| 003585 | 91200 | America's Pharmacy | RxGroup: ARX0302 | America's Pharmacy card |
| 003585 | ASPROD1 | Sam's Club Rx Savings, powered by America's Pharmacy | RxGroup: ALLMBR | Sam's Club card pass |
| 028257 | RXCO | RX.co | RxGroup: 2001 | RX.co discount card |
| 023252 | WCH, WDN, CHRX | WellDyne discount-card routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 008878 | WDN, WTZH | WellDyne and Waltz Health discount routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 020586 | WDN or card-specific | ChicagoRx Card and WellCardRx discount routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 014856 | Not required | RXDC discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 018042 | Card-specific | RXDC discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 020578 | Card-specific | RXDC discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 017564 | Card-specific | RXDC discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 017571 | Card-specific | RXDC discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 018034 | WDF or card-specific | RxMedSaver discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 018794 | Not required | Connect Health Solutions discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 018506 | Not required | Connect Health Solutions discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 022287 | WDN, 8969, or card-specific | CoastalRx discount routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 022725 | WDN | Discount Rx Savings route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 023070 | As on current card | Better Rx discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 023534 | PRX or card-specific | PirateRx discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 024334 | WDINT or card-specific | AffordableMeds discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 024301 | WDN or card-specific | RxNxt discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 025367 | WDN or card-specific | Savascript Value Services discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 022501 | WDN or card-specific | Savascript Value Services discount route | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
| 639858 | Named cash-card PCNs in source | Waltz Health Cash Card discount routes | Card / eligibilityUse the RxGroup on the current member card or returned by the payer's eligibility response or instructions. | WellDyne, May 2026 |
When the directory and card disagree
NCPDP explains that it assigns processor BINs but does not track each number's later history. Processors publish current combinations through payer sheets, while plans communicate client-specific routes through cards and eligibility systems.
- The processor may have retired an older BIN or PCN after a directory source was published.
- The plan may use a client-specific PCN or group that is absent from a processor's public summary.
- The patient's profile may still contain a prior-year route after a plan change.
When the directory and a current payer response conflict, use the current response and document where the replacement route came from. For field behavior and routing rejects, use the RX BIN, PCN, and group guide. For the returned code itself, use the pharmacy claim reject-code reference.
WellDyne source change, May 13, 2026: the version history removes BINs 021429 and 024319 and PCN BRX for BIN 023070. These are not retained as current published examples here. The document is internally inconsistent for 025036/ORX26: its table retains the pair while its change log says it was removed. Verify that pair with WellDyne and the current card. Removal from this document does not establish validity for another processor. Source, pages 1–4.
Sources24 linked sources
- CMS Medicare Prescription Payment Plan final part one guidance, February 2024, section 50.1
- CVS Caremark commercial payer sheet v2.0.8, effective January 2026
- CVS Caremark Medicare payer sheet v2.0.7, effective January 2026
- OptumRx commercial and Medicaid payer sheet, effective January 2026
- OptumRx Medicare payer sheet, effective January 2026
- OptumRx UnitedHealthcare BIN 610279 payer sheet, effective January 2026
- OptumRx coordination-of-benefits payer sheet, effective January 2026
- Prime Therapeutics commercial payer sheet, published December 2025
- Prime Perspective fourth quarter 2025, published December 2025
- Navitus pharmacy provider manual v202601
- MedImpact legacy Elixir comprehensive payer sheet, April 2025
- CMS contract-plan BIN and PCN file, effective July 2026
- CMS Medicare Limited Income NET resources
- CMS Medicare GLP-1 Bridge pharmacy instructions, July 2026
- Judi Rx pharmacy resources
- Abarca pharmacy provider manual
- Liviniti pharmacy resources and Pharmacy Services Manual, March 2026
- SmithRx payer sheet, effective October 2025
- WellDyne current pharmacy resource page and commercial and discount payer sheet, May 13, 2026
- MassHealth Pharmacy Facts 264, corrected 2026 BIN, PCN, and group list
- TRICARE pharmacy BIN, PCN, and group FAQ, October 2024
- NCPDP, Processor ID (BIN), assignment and tracking limits
- Medi-Cal Rx, Appendix D, NCPDP reject codes, April 2026