Pharmacy Insurance Flashcards
Submitting a claim to a prescription drug insurance plan, requires what type of numbers from the patient’s card?
- Bank identification number (BIN)
- Processor control number (PCN)
- Group number
- ID number
What institution has a 6-digit number identification of an accepted electronic pharmaceutical claim?
Bank identification number (BIN)
What set of numbers, letters, or combination of both where the supplement information is provided by the BIN called?
Processor control number (PCN)
What is an employer group that has a pharmacy plan called?
Group number
What is a patient’s single policy where their benefits and terms of coverage vary from each person within the same employer group called?
ID Number
What is the type of payment where patient pays full cost of the prescription without the help of any third party payers
Self-pay
What is an entity that is outside of the patient-pharmacist relationship that is involved in the financial transaction?
Third party payer
Who is the first party within the transaction of a third party payer?
Pharmacy
Who is the second party within the transaction of a third party payer?
Patient (or customer)
Who is the third party within the transaction of a third party player?
Insurance company (or other party)
What request gets submitted to an insurance company for the payment of a product or service
Insurance claim
How is an insurance claim paid?
The insurance company will send payment to the provider on behalf of the patient, once the terms of the policy coverage of product or service is specified
What is the cost of maintaining active insurance coverage called?
Insurance premium
What payment must a patient pay out-of-pocket (in addition to the premium) before the insurance benefits are realized called?
Deductible
What is the payment by the insured individual according to the terms of the insurance policy called?
Co-payment (or co-pay)
The insurance company pays the remaining expense
