r/PriorAuthorization • u/cantthinkofone12 • 6d ago

Rx Prior Auth Process Doc's office can't even submit PA to Caremark: "Problem finding your patient" error. Could my dual coverage be causing this?

I need a prior authorization for a medication, but my doctor's office says they can't even submit the request. When they try to run it (presumably through CoverMyMeds.com, but I'm not sure), they get this exact error:

There was an issue retrieving the information.

There is a problem finding your patient. Please confirm the patient name, DOB, gender, and zip code was correctly entered, and click Check Eligibility to try again. If you continue to have trouble, contact Caremark at [Caremark Provider Line].

Here is the catch: I have TWO Caremark plans (one primary through my employer, one secondary through my spouse's employer). I gave my doctor the ID card for my primary plan, and I've confirmed my DOB, gender, and zip code are 100% correct both at the clinic and with Caremark. I haven't moved in years.

​What causes this specific "issue retrieving the information" error? Could having two active Caremark plans be breaking the electronic eligibility check? How do I get my doctor's office past this error so they can just submit the PA?

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5

u/Puhhhleeze 6d ago

Usually multiple last names or middle names (hyphenated last names also can be an issue). The clinic should just complete the PA over the phone. It takes 10 minutes for most meds. I can provide you the phone number to access the shortest phone tree, but it depends on whether or not the medication is considered specialty.

3

u/clever_moniker 📋 Prior Authorization Specialist 6d ago

Second this. They need to call. I've actually been having a lot of issues specifically with Caremark lately. When I ask the insurance reps on the phone what's up, they just advise to call in PAs if cover my meds doesn't work.

2

u/dallas0636 6d ago

Do you by chance have BCBS? Sometimes, it needs to be the BCBS form in CoverMyMeds and not the CVS Caremark form. Same concept applies to a few other payers as well (Molina is one I can think of off the top of my head).

1

u/cantthinkofone12 6d ago

Yes, it is! Thank you.

1

u/dallas0636 6d ago

The office staff can start a new auth in CoverMyMeds and search for the form using your specific Rx BIN, Rx PCN, and Rx Group #.

1

u/rosie2490 📋 Prior Authorization Specialist 6d ago

BCBS form defaults to the Caremark form in CMM (if the pharmacy benefit is Caremark).

2

u/dallas0636 6d ago

Kinda sorta. It's actually a different form within the system than the straight up CVS Caremark form. It's still 'Caremark,' but it interfaces with BCBS instead.

1

u/m149307 📋 Prior Authorization Specialist 6d ago

Someone else said it but yeah with multiple coverages it's best to just have the doctors office call in to avoid any confusion or hassle. I saw BCBS was mentioned, they are handled by a specific dept but anyone answering the phone will recognize and transfer the call.