Deductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inFormularyakapreferreddrug listOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledAverageWholesalePriceAWPPreferredProviderOrganizationsPPOsCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedReferralofficialapprovedconsent fromthe pcp foradditionalservicesPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionNPINationalProviderNumberCMNcertificateof medicalnecessityPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsTricareinsurance foractive andretiredmembers of themilitary andtheir familiesMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65CommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledFlexibleSpendingAccountFSACopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsHealthMaintenanceOrganizationsHMOsPCNprocessorcontrolnumberMedicarePart Ahospitalcoverage foranyone over65 ordisabledBINbankidentificationnumberHealthSavingsAccountHSAworker'scompcovers illnessor injuriescaused by orrelated toone's jobDurableMedicalEquipmentDMEin-networkprovidersthose withwhom theinsurance co.has a workingcontractMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inFormularyakapreferreddrug listOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledAverageWholesalePriceAWPPreferredProviderOrganizationsPPOsCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedReferralofficialapprovedconsent fromthe pcp foradditionalservicesPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionNPINationalProviderNumberCMNcertificateof medicalnecessityPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsTricareinsurance foractive andretiredmembers of themilitary andtheir familiesMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65CommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledFlexibleSpendingAccountFSACopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsHealthMaintenanceOrganizationsHMOsPCNprocessorcontrolnumberMedicarePart Ahospitalcoverage foranyone over65 ordisabledBINbankidentificationnumberHealthSavingsAccountHSAworker'scompcovers illnessor injuriescaused by orrelated toone's jobDurableMedicalEquipmentDMEin-networkprovidersthose withwhom theinsurance co.has a workingcontractMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& B

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