in-networkprovidersthose withwhom theinsurance co.has a workingcontractPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BMedicarePart Ahospitalcoverage foranyone over65 ordisabledHealthMaintenanceOrganizationsHMOsNPINationalProviderNumberMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledCommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsFlexibleSpendingAccountFSAOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsHealthSavingsAccountHSAworker'scompcovers illnessor injuriescaused by orrelated toone's jobCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitFormularyakapreferreddrug listCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledAverageWholesalePriceAWPCMNcertificateof medicalnecessityDurableMedicalEquipmentDMEPreferredProviderOrganizationsPPOsBINbankidentificationnumberPCNprocessorcontrolnumberMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65Referralofficialapprovedconsent fromthe pcp foradditionalservicesTricareinsurance foractive andretiredmembers of themilitary andtheir familiesMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsin-networkprovidersthose withwhom theinsurance co.has a workingcontractPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BMedicarePart Ahospitalcoverage foranyone over65 ordisabledHealthMaintenanceOrganizationsHMOsNPINationalProviderNumberMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledCommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsFlexibleSpendingAccountFSAOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsHealthSavingsAccountHSAworker'scompcovers illnessor injuriescaused by orrelated toone's jobCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitFormularyakapreferreddrug listCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledAverageWholesalePriceAWPCMNcertificateof medicalnecessityDurableMedicalEquipmentDMEPreferredProviderOrganizationsPPOsBINbankidentificationnumberPCNprocessorcontrolnumberMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65Referralofficialapprovedconsent fromthe pcp foradditionalservicesTricareinsurance foractive andretiredmembers of themilitary andtheir familiesMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernments

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