Auditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BBINbankidentificationnumberReferralofficialapprovedconsent fromthe pcp foradditionalservicesPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsFlexibleSpendingAccountFSAin-networkprovidersthose withwhom theinsurance co.has a workingcontractDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65MedicarePart Ahospitalcoverage foranyone over65 ordisabledMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsHealthMaintenanceOrganizationsHMOsworker'scompcovers illnessor injuriescaused by orrelated toone's jobPreferredProviderOrganizationsPPOsTricareinsurance foractive andretiredmembers of themilitary andtheir familiesPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedCMNcertificateof medicalnecessityCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsHealthSavingsAccountHSAAverageWholesalePriceAWPPCNprocessorcontrolnumberDurableMedicalEquipmentDMEFormularyakapreferreddrug listNPINationalProviderNumberMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledCommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BBINbankidentificationnumberReferralofficialapprovedconsent fromthe pcp foradditionalservicesPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsFlexibleSpendingAccountFSAin-networkprovidersthose withwhom theinsurance co.has a workingcontractDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65MedicarePart Ahospitalcoverage foranyone over65 ordisabledMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsHealthMaintenanceOrganizationsHMOsworker'scompcovers illnessor injuriescaused by orrelated toone's jobPreferredProviderOrganizationsPPOsTricareinsurance foractive andretiredmembers of themilitary andtheir familiesPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedCMNcertificateof medicalnecessityCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsHealthSavingsAccountHSAAverageWholesalePriceAWPPCNprocessorcontrolnumberDurableMedicalEquipmentDMEFormularyakapreferreddrug listNPINationalProviderNumberMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledCommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployers

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