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Insurance Crossword

Across
Alpha-numeric identifier found on the insurance card that is specific to an individual or family, and used to process an insurance claim.
Insurance plan where patient can access specific providers and services in the network at a reduced cost, or use providers and services outside of the network at a higher cost.
A number found on an insurance card that identifies the covered member’s employer and specific type of insurance plan.
A standard measure and mean value at which drugs are sold to pharmacies, physicians, or other customers; usually 20% greater than the manufacturer’s price.
Least restrictive insurance plan where the patient can use any provider or service and pays a percentage of the charge, e.g., patient pays 20% / insurance covers 80%.
The insurance company’s written explanation of the details of payment for services/products.
Originally established in the banking industry, a 6 digit number found on the patient’s insurance card that tells the pharmacy which PBM should be billed for the claim.
Term used in the insurance industry for the process of paying or denying claims based on the patient’s plan/coverage.
Privately administered, federally-funded program for the elderly and disabled which covers most prescription medications.
A list of medications covered on the patient's drug plan.
Federal law that protects patients’ privacy and the security of their health information.
Amount the patient must pay out-of-pocket before the insurance company pays anything toward the Rx or medical care.
Billable card, often funded by drug companies or private organizations, to financially assist those without Rx benefits.
Down
Restrictive insurance plan where the patient utilizes specific providers and services within the “network” to reduce costs.
Occurs when an insurance company denies a claim for reasons such as “drug not on the formulary”, “day’s supply limitation”, “refill to soon”, or “high dose”
Along with the BIN, it’s a number found on the patient’s insurance card that further routes the pharmacy claim to the correct PBM.
A written or verbal order from a prescriber to a pharmacist specifying an individual patient, specific medication, and explicit directions for use.
A rejection message from the insurance company saying that the patient must use up a designated percentage of the medication before they will pay for a refill.
Red, white, and blue insurance card with coverage to a federally-funded program for the elderly and disabled. Covers doctor’s visits, healthcare services, and some pharmacy-related items such as diabetic supplies.
State-funded program for low income families, children, and expecting mothers, that pays for healthcare services, most prescriptions and some OTCs.
A computer message alert sent to the pharmacy by the insurance company stating that the claim is rejected until “special approval” criteria are met.
The number of days the medication will last the patient. It is entered into the computer software when filling a prescription.
Intermediary claims processor that works with pharmacies (which submit prescription claims) and insurance companies (which pay for the claims)
After meeting a deductible, it is a flat fee or percentage of the Rx or medical cost that the patient pays at the time of service.
A computer alert that halts the prescription filling process when potential harm is detected by the pharmacy’s software (e.g. drug interaction, allergy).