Copayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsNPINationalProviderNumberCMNcertificateof medicalnecessityDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionin-networkprovidersthose withwhom theinsurance co.has a workingcontractReferralofficialapprovedconsent fromthe pcp foradditionalservicesBINbankidentificationnumberOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledworker'scompcovers illnessor injuriescaused by orrelated toone's jobHealthMaintenanceOrganizationsHMOsMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledHealthSavingsAccountHSAMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BDurableMedicalEquipmentDMECommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65AverageWholesalePriceAWPCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedMedicarePart Ahospitalcoverage foranyone over65 ordisabledPreferredProviderOrganizationsPPOsFlexibleSpendingAccountFSAAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsTricareinsurance foractive andretiredmembers of themilitary andtheir familiesPCNprocessorcontrolnumberFormularyakapreferreddrug listCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsNPINationalProviderNumberCMNcertificateof medicalnecessityDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionin-networkprovidersthose withwhom theinsurance co.has a workingcontractReferralofficialapprovedconsent fromthe pcp foradditionalservicesBINbankidentificationnumberOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledworker'scompcovers illnessor injuriescaused by orrelated toone's jobHealthMaintenanceOrganizationsHMOsMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledHealthSavingsAccountHSAMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BDurableMedicalEquipmentDMECommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65AverageWholesalePriceAWPCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedMedicarePart Ahospitalcoverage foranyone over65 ordisabledPreferredProviderOrganizationsPPOsFlexibleSpendingAccountFSAAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsTricareinsurance foractive andretiredmembers of themilitary andtheir familiesPCNprocessorcontrolnumberFormularyakapreferreddrug list

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