CommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionAverageWholesalePriceAWPFormularyakapreferreddrug listCMNcertificateof medicalnecessityAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsReferralofficialapprovedconsent fromthe pcp foradditionalservicesMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledin-networkprovidersthose withwhom theinsurance co.has a workingcontractPreferredProviderOrganizationsPPOsOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65MedicarePart Ahospitalcoverage foranyone over65 ordisabledNPINationalProviderNumberTricareinsurance foractive andretiredmembers of themilitary andtheir familiesHealthSavingsAccountHSAworker'scompcovers illnessor injuriescaused by orrelated toone's jobFlexibleSpendingAccountFSAPCNprocessorcontrolnumberHealthMaintenanceOrganizationsHMOsCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitBINbankidentificationnumberDurableMedicalEquipmentDMECommercialInsurancenongovernmental,private insurancethat they pay foron their own orsubsidized by theiremployersMedicaidcoverage for low-income, disabled,unemployed runby federal andstategovernmentsPriorAuthorization(PA)PBM wants tocommunicate withthe dr. to get moreinformation aboutthe ongoing needfor a prescriptionAverageWholesalePriceAWPFormularyakapreferreddrug listCMNcertificateof medicalnecessityAuditchecking of thepharmacy'sprescriptionrecords tochallengeproblemsReferralofficialapprovedconsent fromthe pcp foradditionalservicesMedicarePart Bcoversdoctor's visitsfor anyoneover 65 ordisabledin-networkprovidersthose withwhom theinsurance co.has a workingcontractPreferredProviderOrganizationsPPOsOnlineAdjudicationelectronicallysubmitting rxclaims to theappropriatePBMsPharmacyBenefitManagerdivision ofinsuranceco. thatprocessespt. rx claimsMedicarePart Dprescriptionsdrug coveragefor anyoneover 65 ordisabledMedicarePart Coffers the fullpackage ofhospital, doctorvisits, and rx druginsurance foranyone over 65MedicarePart Ahospitalcoverage foranyone over65 ordisabledNPINationalProviderNumberTricareinsurance foractive andretiredmembers of themilitary andtheir familiesHealthSavingsAccountHSAworker'scompcovers illnessor injuriescaused by orrelated toone's jobFlexibleSpendingAccountFSAPCNprocessorcontrolnumberHealthMaintenanceOrganizationsHMOsCharge-backpost-claimrejection of arx claim by aPBM that mustbe investigatedDeductibleamount of annualmedical costs thatmust be paidbefore fullcoverage byinsurance co.kicks inMedigapinsurancesupplementalplan from aprivate insurancecompany to helpcover Medicare A& BCopayflat out-of-pocket fee thatpt. is requiredto pay for eachhealth visitBINbankidentificationnumberDurableMedicalEquipmentDME

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