MedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsTricareinsurance foractive andretiredmembers of themilitary andtheir familiesin-networkprovidersthose withwhom theinsurance co.has a workingcontractAverageWholesalePriceAWPMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BCMNcertificateof medicalnecessityCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inNPINationalProviderNumberFormularyakapreferreddrug listworker'scompcovers illnessor injuriescaused by orrelated toone's jobPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionPCNprocessorcontrolnumberMedicarePart Ahospitalcoverage foranyone over65 ordisabledMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65FlexibleSpendingAccountFSAPreferredProviderOrganizationsPPOsReferralofficialapprovedconsent fromthe pcp foradditionalservicesDurableMedicalEquipmentDMEHealthMaintenanceOrganizationsHMOsHealthSavingsAccountHSACharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedCommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersBINbankidentificationnumberMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsTricareinsurance foractive andretiredmembers of themilitary andtheir familiesin-networkprovidersthose withwhom theinsurance co.has a workingcontractAverageWholesalePriceAWPMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BCMNcertificateof medicalnecessityCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inNPINationalProviderNumberFormularyakapreferreddrug listworker'scompcovers illnessor injuriescaused by orrelated toone's jobPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionPCNprocessorcontrolnumberMedicarePart Ahospitalcoverage foranyone over65 ordisabledMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65FlexibleSpendingAccountFSAPreferredProviderOrganizationsPPOsReferralofficialapprovedconsent fromthe pcp foradditionalservicesDurableMedicalEquipmentDMEHealthMaintenanceOrganizationsHMOsHealthSavingsAccountHSACharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedCommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersBINbankidentificationnumber

Pharmacy Insurance Terms - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.


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  1. covers doctor's visits for anyone over 65 or disabled
    Medicare Part B
  2. division of insurance co. that processes pt. rx claims
    Pharmacy Benefit Manager
  3. checking of the pharmacy's prescription records to challenge problems
    Audit
  4. insurance for active and retired members of the military and their families
    Tricare
  5. those with whom the insurance co. has a working contract
    in-network providers
  6. AWP
    Average Wholesale Price
  7. supplemental plan from a private insurance company to help cover Medicare A & B
    Medigap insurance
  8. certificate of medical necessity
    CMN
  9. flat out-of-pocket fee that pt. is required to pay for each health visit
    Copay
  10. prescriptions drug coverage for anyone over 65 or disabled
    Medicare Part D
  11. amount of annual medical costs that must be paid before full coverage by insurance co. kicks in
    Deductible
  12. National Provider Number
    NPI
  13. aka preferred drug list
    Formulary
  14. covers illness or injuries caused by or related to one's job
    worker's comp
  15. PBM wants to communicate with the dr. to get more information about the ongoing need for a prescription
    Prior Authorization (PA)
  16. processor control number
    PCN
  17. hospital coverage for anyone over 65 or disabled
    Medicare Part A
  18. coverage for low-income, disabled, unemployed run by federal and state governments
    Medicaid
  19. electronically submitting rx claims to the appropriate PBMs
    Online Adjudication
  20. offers the full package of hospital, doctor visits, and rx drug insurance for anyone over 65
    Medicare Part C
  21. FSA
    Flexible Spending Account
  22. PPOs
    Preferred Provider Organizations
  23. official approved consent from the pcp for additional services
    Referral
  24. DME
    Durable Medical Equipment
  25. HMOs
    Health Maintenance Organizations
  26. HSA
    Health Savings Account
  27. post-claim rejection of a rx claim by a PBM that must be investigated
    Charge-back
  28. nongovernmental, private insurance that they pay for on their own or subsidized by their employers
    Commercial Insurance
  29. bank identification number
    BIN