ExCPT Chapter 4 Order Intake and Entry
to submit a claim to a prescription drug insurance plan, you must obtain the
following four numbers from the patient's insurance card? - correct answer-1.
BIN
2. PCN
3. Group number
4. ID number
what does BIN stand for? - correct answer-bank indentifaction number. the
BIN number is a 6 digit number used for processing pharmacy claims
electronically. it identifies the bank or institution that will accept the claim.
what is the PCN? - correct answer-processor control number supplements the
info provided by the BIN. together, this info functions much like the routing
number on a check. the PCN does not have a standardized format, it can vary
in length and may be composed of numbers, letters, or a combination of both.
what is a group number? - correct answer-The group number identifies the
employer group or the type of plan to which the patients plan belongs.
what is a ID number? - correct answer-the benefits and terms of coverage
vary from one person to another, even for people within the same employer.
the ID number identifies the patient individual policy.
what is self pay? - correct answer-means the patient or customer pays full
cost of the prescription without the help of any third party payers.
what is a third party payer? - correct answer-An entity outside of the
patient-pharmacist relationship that is involved in the financial transaction. The
patient is the first party in the transaction, the pharmacy is the second party,
and the insurance company (or other payer) is the third party.
what is an insurance premium? - correct answer-is the cost of maintaining
active insurance coverage.
what is a deductible? - correct answer-amount of money a patient must pay
out of pocket before insurance benefits are realized.
to submit a claim to a prescription drug insurance plan, you must obtain the
following four numbers from the patient's insurance card? - correct answer-1.
BIN
2. PCN
3. Group number
4. ID number
what does BIN stand for? - correct answer-bank indentifaction number. the
BIN number is a 6 digit number used for processing pharmacy claims
electronically. it identifies the bank or institution that will accept the claim.
what is the PCN? - correct answer-processor control number supplements the
info provided by the BIN. together, this info functions much like the routing
number on a check. the PCN does not have a standardized format, it can vary
in length and may be composed of numbers, letters, or a combination of both.
what is a group number? - correct answer-The group number identifies the
employer group or the type of plan to which the patients plan belongs.
what is a ID number? - correct answer-the benefits and terms of coverage
vary from one person to another, even for people within the same employer.
the ID number identifies the patient individual policy.
what is self pay? - correct answer-means the patient or customer pays full
cost of the prescription without the help of any third party payers.
what is a third party payer? - correct answer-An entity outside of the
patient-pharmacist relationship that is involved in the financial transaction. The
patient is the first party in the transaction, the pharmacy is the second party,
and the insurance company (or other payer) is the third party.
what is an insurance premium? - correct answer-is the cost of maintaining
active insurance coverage.
what is a deductible? - correct answer-amount of money a patient must pay
out of pocket before insurance benefits are realized.
