Bin pcn group A list of BIN/PCN/ group number combinations for MassHealth . BIN/PCN and member ID are the only information needed to process a claim. CareFirst IDs have plan code 193/693 Out-of-area coverage (BlueCard) Logo description What it looks like What it means (type of out-of-area coverage) A blank (empty) suitcase icon Member has out‑of‑area coverage for urgent or emergency care. ” To prevent point of service disruption, the RxGroup must be submitted on all claims and reversals. If there is no bin I tell the patient that I need their pharmacy card. Ø NCPDP ECL Version: Oct 2Ø23 NCPDP BIN/PCN/Group Numbers for ACOs, MCOs, PCC Plan, MassHealth-Only SCOs . Please note, the data The following tables show the correct combinations, effective for calendar year 2023, for pharmacies for Accountable Care Partnership Plans (ACPPs), Primary Care Number (BIN), Processor Control Number (PCN) and Submitted Group (Group) code information as listed below and on our member identification (ID) cards. Sample ID card images can be found below. The TRICARE As of January 1, 2021, all Cigna Healthcare SM Commercial pharmacy plans and Cigna Healthcare Medicare claims are adjudicating on the Express Scripts systems. Your PCN or processor control number is used by your pharmacy to locate your pharmacy member profile. 864. RX BIN & PCN: Script Care pharmacy claims BIN and PCN identifier numbers. 4892 610830 RRXHCU 855. Last updated: December 2024 Added BIN/PCN Combination BIN 025771 PCN IRXCOMAP . What do I use for the member's MORx ID number? Commercial, Medicaid and MA Only BIN: 610494 PCN: 9999 Community Health BIN: 610613 PCN: 2417 United Healthcare Community Plan of Indiana BIN: 610494 PCN: 4841 3Ø1-C1 GROUP ID M Always required. Plan Name/Group Name BIN PCN Legacy ESI Medicaid ØØ3858 A4 (or as assigned by ESI) SC (Use when secondary to Medicare Part D only) MA (refer to member’s card) Legacy Medco Medicaid 61ØØ14 As provided on card or anything except zeros Legacy Medco – Secondary to Medicare Part D Plan Name/Group Name: ALL PLANS BIN: 020040 PCN: *N/A *FOR COMMUNITY HEALTH NETWORK ONLY USE PCN: AE7271 Plan Name/Group Name: ALL TEST CLAIMS BIN: 020040 PCN: N/A Processor: LAKER/MEDONE NCPDP Telecommunication Standard Version/Release #: D. Rx Group. Plan Name/Group Name: MRx Commercial – Standard BIN: 017449 PCN: 6792000 Plan Name/Group Name: MRx Commercial – Employee Benefit Management Services BIN: 017431 PCN: EBMS Plan Name/Group Name: FlexScripts BIN: 017472 PCN: FLEXRX Plan Name/Group Name: MRx Commercial – Union BIN: 017449 PCN: UNION Payer Name: Magellan Rx Program Claim BIN Claim PCN Claim Group STAR 020107 CS WKEA CHIP 020107 CS WKEA STAR+PLUS 020107 CS WKEA STAR+PLUS MMP 020115 IS WKUA STAR Kids 020107 CS WKEA Blue Cross Blu e Shield of Texas PBM: Prime Therapeutics Blue Cross Blue Shield of Texas - Pharmacy Enrollment STAR, CHIP, STAR Kids phone: 888-277-5510 BIN 026309 PCN KYPROD1 GROUP KYF01 Single PBM MedImpact MedImpact Kentucky Medicaid Bin/PCN/Group Numbers Effective 1/1/2024 023880 KYM01. Group #: URX22 BIN #: 610020 PCN #: URX001. WDRX : KD . MCO, ACO, and PCC plans also may be found in Appendix A of this document. ANSI BIN # 001553 Processor Control # NVM Provider ID # National Provider Identifier (NDC) • A group number is not needed for a Nevada Medicaid transaction. WDRX : the new Member ID Number, Rx Group, BIN, and PCN. These numbers allow your pharmacy or doctor to process claims the right way. PCN – DRTXPROD . Same for BCBs. Behavioral Health . PCN List for BIN 610241 . A Pharmacy Support Specialist will be happy to assist you. 1404 GENERAL INFORMATION Payer Name: RealRx / Cooperative Benefits Group Date: January 1, 2023 Plan Name/Group Name: ALL Processor: CoverMyMeds (formerly PHS/RelayHealth) Effective as of April 1, 2020 NCPDP Telecommunication Standard And you can still add the card BIN, PCN, group number, and any patient ID to a patient’s profile at any time. Save up to $4 per prescription. • If the E1 query returns a telephone number for Contract ID “X0001,” the patient is Plan Name/Group Name: California Department of Public Health, Office of AIDS, AIDS Drug Assistance Program (CDPH/OA/ADAP) BIN: 018786 PCN: ADAP Medicare: TROOP PCN: ADAP Non-Medicare: 222327 Processor: Magellan Rx Management Effective as of: 07/01/2016 NCPDP Telecommunication Standard Version/Release #: D. jump Created Date: The Group, like the BIN/IIN and PCN appears on the pharmacy ID card, in accordance with the rules defined in the NCPDP Pharmacy ID and Combination Card Implementation Guide. O. system with the new Member ID Number, BIN, PCN and Rx Group. Sales tax may apply and is not included. Super quick and easy. Another difference between our program and Medicaid is that we reimburse on a fee-for-service basis and STEP 2. RX21BE; CVS-Caremark 844-910-3446 BIN 610591 20107 610649 4336 4336 610494 11529 PCN ADV KY 3191501 MCAIDADV MCAIDADV 4040 P022011529 GROUP RX8831 WKVA RX5035 RX8893 ACUKY KY Medicaid PBM CVS Caremark IngenioRx Humana Pharmacy Solutions CVS Caremark CVS Caremark Optum Rx Magellan Kentucky Medicaid Bin/PCN/Group Numbers Effective These are all of the BIN/PCN/Group ID numbers that will be accepted by ACS: Former Codes New Codes Who BIN PCN from Pharmacy NCPDP Group ID from Pharmacy BIN PCN from Pharmacy NCPDP Group ID from Pharmacy BCCDT 010454 P012010454 MDBCCDT 610084 DRDTPROD MDBCCDT KDP 010454 P012010454 MDKDP 610084 DRKDPROD MDKDP Ancira Auto Group MaxorPlus Texas 005377 10000019 800-687-0707 Plan Name / Network Name PBM/ Processor Region BIN PCN/ Group Help Desk Anderson Corporation Pharmacare National 610468 HP, Gr 60351000 800-777-1023 Anthem Rx Network Anthem National 610575 00890000 or 00990000 800/662-0210 ANA - 1 Network Argus National 600428 Call h/desk BIN/PCN/Group Numbers for ACOs, MCOs and PCC Plan The three tables below shows the correct combinations effective March 1, 2018, for pharmacies to use when submitting MassHealth ACO/MCO/FFS pharmacy claims. Plan Name BIN PCN Arkansas Blue Cross Blue Shield Medi-Pak Rx (PDP) Ø16895Arkansas Blue Cross Blue Shield Medi HMOAR2 Arkansas Blue Cross Blue Shield Medi-Pak Rx Group (PDP) PDPARG Arkansas BlueMedicare Saver Choice (PPO) Arkansas BlueMedicare Value Choice (PPO) PPOAR2 Arkansas BlueMedicare Premier Choice (PPO) BCBS of Alabama Aka 004336 and pcn is ADV. It is often accompanied by other important information such as your name, policy number, group number, and plan name. Last updated Dec 8. • Leading zeroes in the NCPDP The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2024 Medicare Part D plan sponsor. Box 7012 : Downey, CA 90242: California (Southern CA) 11172: SCCMS SC: 94 APPENDIX A: BIN / PCN COMBINATIONS 3Ø1-C1 Group ID R As printed on the ID card or as communicated 3Ø3-C3 Person Code R As printed on the ID card 3Ø6-C6 Patient Relationship Code R Your (1) Member ID number, (2) Rx BIN, (3) PCN, and (4) Group ID (or Rx Group) number are the four numbers that uniquely identify you and your Medicare Part D prescription drug plan – and these four numbers are usually found on your Medicare Part D Member ID card and most of your Medicare plan correspondence or printed on your Medicare plan 2022 Medicare Prescription Drug Plan Pharmacy BIN and PCN Numbers: Contract ID: Contract Name: Plan ID: BIN: PCN: E0654: TEAMStar Medicare Part D Prescription Drug Program: all plans: 015574: ASPROD1: E3014: Pennsylvania Public School Employees Retirement Sy: all plans: 610097: 9999: E4744: MISSOURI DEPARTMENT OF paperwork, which BIN, PCN, and group should I use to submit these claims? Beginning 10/1/17, all pharmacy claims regardless of date of service (DOS) must be submitted to MMA using the following claim routing information. Social Share. Ø NCPDP ECL Version: Oct 2Ø23 NCPDP Emergency ECL Version: July 2Ø23 Pharmacy Help Desk Information It is often preceded by a prefix, known as the PCN (Processor Control Number), which further specifies the plan or PBM associated with the Bin number. Click here for Pharmacy Benefit Administrator, BIN, PCN, Group, and telephone number Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Pharmacies are encouraged to begin using the BIN/PCN combination after January 1, 2012. If you have Medicare Part D, your PCN is SC. contract type single. Some entities may use the Group ID; still others may not need this level of differentiation. Accountable Care Partnership Plans MCO Partner PBM BIN PCN Group BMC HealthNet Plan Following are billing instructions for the Medicaid Plans: BIN: 004336, PCN: MCAIDADV GRP: RX0546, RX6422, RX6423 Following are billing instructions for the Essential Plans: BIN: 004336, PCN: ADV GRP: RX6424 NCPDP D. Payer ID: 41161. Reply reply harley121778 Plan Name/Group Name: Illinois Medicaid BIN: Ø178Ø4 PCN: ILPOP Processor: Change Healthcare (CHC) Effective as of: April Ø6, 2Ø23 NCPDP Telecommunication Standard Version/Release #: D. WDRX 888: RWTONECAL . BCN HMO products for employer groups Subscriber Name VALUED CUSTOMER Subscriber ID Issuer (80840) Group Number Network Deductible ($) 0,000/0,000 0,000/0,000 0,000/0,000 0,000/0,000 a secondary claim to IQVIA using BIN 601341. How to use this coupon. Tailored Plan Pharmacy Help Desk Contact Information Tailored Plan ANSI BIN # 001553 Processor Control # NVM Provider ID # National Provider Identifier (NDC) • A group number is not needed for a Nevada Medicaid transaction. conduent. The North Carolina Medicaid Division of Health Benefits website contains everything you need to know about outpatient pharmacy services. CareCard is the best one. Please contact specific MCO for OptumRx Part-D and MAPD Plans BIN: 610097 PCN: 9999 Part-D WRAP Plans BIN: 610097 PCN: 8888 PCN: 8500 OptumRx (This represents former informedRx) BIN: 610593 PCN: BIN/PCN Table . Group # Submit using the 10-digit Group (or GRP) number beginning with EC and AC found on the savings offer or saved in the patient’s profile. Medi-Cal Rx NCPDP Payer PCN: Group Number PBM: Phone Number. 0 January 1, 2019 017142 ASPROD1 ML284 Medicaid D. • The Nevada Medicaid Pharmacy card will list the recipient’s ID number, name and date of birth. pcp name b smith. AHCCCS FFS and MCO Contractors BIN, PCN and Group ID's effective 1/1/24; AHCCCS FFS and MCO Contractors BIN, PCN and Group ID's effective 4/1/23; Contact Us. For questions regarding setup, claim transmission, patient eligibility, or other issues, call the Company PBM BIN# PCN# Group# Pharmacy Helpdesk# Eligibility Helpdesk# Override Process Amerigroup Caremark 004336 ADV RX4281 1-800-454-3730 1-800-454-3730 Enter PAMC code 11112222333 for 3 day supply Blue Choice Wellpoint NextRX 610575 00890000 Leave blank 1-866-915- 0327 1-866-757-8286 No code necessary – For KHC drug claims, the BIN is 025417, the PCN is DRTXPRODKH and the Group is KHC. inpatient hosp copay $500. PCN: Sample ID Card If you need a member’s specific prescription processing information or other help with a claim, please visit our Pharmacist Resource Center at https://prc. Click here for In the image above, Jane Smith is listed as person code "04" on the account. Click here for BIN 61Ø648, PCN Ø189ØØØØ This is required when Covered Person’s of Truli have secondary coverage with Truli, BIN Ø12833, PCN THP This is required when Covered BIN: 610378 PCN: SC1 Group: 2060 Member ID: 100126 THIS CARD IS NOT INSURANCE SAVE UP TO 80% on prescription drugs at virtually All Major Pharmacies! Brought to you by in The chart below is the fourth page of the 2022 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H5337 through H7322. 0 January 1, 2019 BIN Number: 025052 PCN: MCAIDADV Group Number: RX22AC. On the Vendor Drug Program webpage you can search the Texas Drug Code Formulary to find contracted KHC Group Medicare Advantage PPO CareFirst BlueCross BlueShield Group Advantage (PPO) Prefix–EGE. after [June 1, 2015], use the following BIN/PCN/GroupRx information: Claim Submission Information BIN: 003858 PCN: MA Group: WKEA Member ID Cards Amerigroup members will receive a new ID card to use at participating pharmacies. It identifies what type of Pharmacy Benefit Administrator, BIN, PCN, Group, and telephone number Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark Phone: 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX8810 Which BIN number do I enter to adjudicate the claim? Please login to the pharmacy portal and refer to the Payer Sheets. MMP. Most pharmacies enter a single plan into their The claim requires the BIN, PCN, and Group number for each specific MCO for correct processing. This document provides information on electronic claims processing, The chart below is the sixth page of the 2024 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H9001 through X0001. Key Features. Benefits/Claims – Medica: 1-800-458-5512 . ; The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and Rx BIN: Rx Group: Rx PCN: 10-digit numeric ID unique to each patient: 610728: Listed on our claims help resources page: PANF: Submit a manual claim 1. Updates information in Pharmacy Facts 160 . Final Publication Date: 20190225 SPAP ADAP BIN PCN Spreadsheet . To adjudicate a claim, you only need to enter the Hippo member ID and our BIN number. 2FDA. 1/1/2020 : 12/31/2020 . This document provides information on electronic claims processing, specific to NCPDP defined fields and requirements, for OptumRx BIN 610279 business. Possible previous billing codes are not listed. Leverage PRECISIONxtract’s dedicated team of payer data experts, our curated relationships to Payers and PBMs, and the BPG Lookup product to map the BIN PCN GROUP identifiers in What do the BIN, PCN, and Rx Group numbers look like? Here is an example, of these three numbers for an older WellCare Medicare Part D prescription drug plan: BIN: The BIN/IIN field will either be filled with the ISO/IEC 7812 IIN or the NCPDP Processor BIN, depending on which one the health plan has obtained. NCPDP Telecommunication Version/Release #: D. Pharmacy Benefits FAQs. 0 PCN List for BIN 610241 MeridianRx PCN Group ID Line of Business MRXMIMCH N/A Commercial BAPMCORX N/A Commercial CMEMCORX N/A Commercial QCPRX N/A Commercial PERCORX N/A Commercial Medicaid Health Plan BIN, PCN, and Group Information Medicaid Health Plan BIN PCN Group Aetna Better Health of Michigan 610591 ADV RX8826 Blue Cross Complete of Michigan 019595 PRX00621 n/a HAP CareSource 003858 MA CSHAPMI McLaren Health Plan 017142 ASPROD1 ML108; ML110; ML284; ML329 Meridian Health Plan 003858 MA 2EPA Pharmacy Benefit Administrator, BIN, PCN, Group, and telephone number Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark Phone: 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX8810 • Group Number: Provided by The Assistance Fund • PCN: AS • Rx BIN: 610600 • Processing Code: 08 • Member Number: Provided by The Assistance Fund • Group Number: Provided by The Assistance Fund • Payor ID: 86753 Please note: Claims submitted to the inappropriate administrator will not be paid. Applicable discounts will be displayed in the transaction response. They can be taken by mouth, injected, inhaled or infused. Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP. Not all entities use the Group to differentiate plans. These medications are often very expensive and require special handling. BIN # (NCPDP #101-A1) = 010900 PCN (NCPDP #104-A4) = 8263342243 (New) Group ID (NCPDP #301-C1) = VAMEDICAID (New) BIN Number: 025986 Version/Release #: D. The PDF417 image, if printed, must be printed as the uppermost item on the back Plan Name/Group Name: AmWINS – Commercial BIN: 025169 PCN: AMWINS Plan Name/Group Name: AmWINSRx BIN: 015185 PCN: CMSPARTD Processor: ELIXIR Effective as of: 9/1/2020. Make sure the claim form and the EOB/RA are legible. PCN RXGROUP/ GROUP ID PHARMACY HELPDESK . The Bin number might be labeled explicitly as “BIN” or “Rx BIN Rx BIN: 004336 Rx Group: Rx21CQ: PCN: ADV: Total Benefit Solutions (Aetna International) 610502 (Aetna) PCN: 00670000: United Healthcare HMO: Rx Vendor: OPTUMRx Rx BIN: 610279 Rx PCN: 9999 Rx Grp: UHCNICE Service Number: 800-788-7871 : United Healthcare PPO: Rx Vendor: OPTUMRx Rx Bin: 610279 The chart below is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3962 through H5928. PBM/processor/plan’s Payer Sheets are shared Rx BIN (Benefit Identification Number) Rx PCN (Processor Control Number) Rx group. 2. Member and Pharmacy Help Desk Phone Number: 1-800-424-1664 Pharmacy Prior Authorizations Phone Number: 1-800-424-1664 The chart below is the fourth page of the 2022 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H5337 through H7322. Q: Is the CSHCN Services Program a subdivision of Medicaid? No. gov BIN: 009430 PCN: NO PCN Group: ALRX9999 24 Customer Service line: 855-828-1484 Retail Copays 30-Day Supply at Preferred Pharmacy 30-Day Supply at Non-Preferred Pharmacy Specialty at Retail Generic $5 $15 35% up to $150 maximum Brand $30 $50 Brand (Non-Preferred) 35% up to $145 35% up to $150 The Rx BIN number on member ID cards is changing to 610011. L436W PIB 9999 PIB TMSTW AKTG AMCTN 610097 Alaska Teamsters United Healthcare Dual Complete (HMO SNP) in Tennessee UnitedHealthcare Dual Complete (HMO SNP) in New York Bin: 015995 PCN: GDC Group: DR33 ID: two letters plus random numbers (example: HF373747) also if patient has more than one script to rebill to GoodRx, you can use the same info for each one Reply reply Ancira Auto Group MaxorPlus Texas 005377 10000019 800-687-0707 Plan Name / Network Name PBM/ Processor Region BIN PCN/ Group Help Desk Anderson Corporation Pharmacare National 610468 HP, Gr 60351000 800-777-1023 Anthem Rx Network Anthem National 610575 00890000 or 00990000 800/662-0210 ANA - 1 Network Argus National 600428 Call h/desk Plan Name/Group Name: Ventegra BIN: 012528 PCN: VENTEG Provider Relations Help Desk Info: 877-867-0943 Payer Name: Ventegra Date: 09/01/2016 Plan Name/Group Name: Ventegra BIN: 018893 PCN: MEDB Provider Relations Help Desk Info: 855-355-3015 Payer Name: LeeHLTH Date: 06/08/2022 Plan Name/Group Name: Ventegra BIN: 025722 PCN: LeeHLTH plan name/group name: bin: pcn: various 006012 pdmi pxxpdmi meddpdm 610020 pdmi pxxpdmi carerx pys 142dc3b crgd 017274 pdmi expo discount card 006012 expodc sipn BIN/PCN/Group Numbers for ACOs, MCOs, PCC Plan, and SCO MassHealth -Only Primary Care ACOs PBM BIN PCN Group Pharmacy Help Desk Community Care 2020 OptumRx BIN 610279 Payer Sheet. Tailored Plan Pharmacy Help Desk Contact Information Tailored Plan MAP/MAP BASIC Card Legend ID#: Member’s Master Record Number. BIN 61Ø648, PCN Ø189ØØØØ This is required when Covered Person’s of Truli have secondary coverage with Truli, BIN Ø12833, PCN THP This is required when Covered Person’s of BCBS of North Dakota USW Union Bobcat group has secondary coverage with BCBS of ND, BIN: 610455 PCN: NDBCSUP 429-DT SPECIAL PACKAGING INDICATOR RW Payer Group Name: SAMPLE GROUP Coverage Type. effective date 01/01/2019. Plan Name BIN PCN Rx Group Some entities may use the Group ID; still others may not need this level of differentiation. Suitcase symbol for nationwide coverage The suitcase image, with or without PPO noted, indicates that the customer’s plan includes BlueCard benefits. 0 018280 January 1, 2019 D. Text. 7 NCPDP Version/Release #: D. Please process their prescription using the above BIN/PCN/Group information. This is a good way to tell your new card apart from your old card. Q1Medicare ®, Q1Rx ®, and Q1Group ® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group. medi-calrx. The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2021 Yes, and now you just have to use “MAKE” for the BIN, PCN, & Group Reply reply Saverking7 • Try 024350 for BIN/PCN/GRP. specialist $25. horizon plan name. This Quick Tip provides an overview of our member ID cards. Each plan will issue unique cards to its members that provide BIN/PCN/group number combinations. BIN/PCN Table . Does Navitus provide a website for pharmacies? Missing/Invalid Group Number-reject 06; Invalid Day BIN PCN Group Member Information Pharmacy Helpdesk Kaweah Health . Group health plan address. c. NEW BIN. 018280. EMP Group ID: 123456 Member I. PLAN BIN PCN Group What is TRICARE’s pharmacy PCN and BIN? The TRICARE PCN is A4. Refer to each member’s ID card. When a member does not have their new card, the pharmacy may identify the member’s pharmacy coverage by the following methods. If Jane Smith fills a prescription with GoodRx Gold, she would present the card to the pharmacist and ask them to 2025 OptumRx BIN 610279 Payer Sheet. A blank PCN will work. The TRICARE pharmacy BIN is 003858. Molina Complete Care (formerly Magellan KidsCare) 004336. b. • If the E1 query returns a Contract ID and help On January 1, 2022, the Department of Health Care Services (DHCS) will change the pharmacy benefit for Medi-Cal members. 019158. BIN Number PCN Group Number(s) Alliance Navitus 610602 MCD Medicaid: TPMC NCHC: TPHC Partners CVS Caremark 025052 MCAIDADV RX22AC Trillium Perform Rx 019595 PRX10811 N/A Vaya Navitus 610602 MCD VAYARX . d. Ask the pharmacist to submit your claim to LI NET using the following: BIN:015599 PCN: 05440000 Note: If you have additional questions, call the LI NET help desk at 800-783-1307 (TTY: 711), Monday – Friday, 8 BIN Number Additional Information Required for Pharmacy Processing; Affinity Health Plan (866) 247-5678; CVS Caremark (800) 364-6331: ADV 004336: Group: RX4212. NEW PCN. 18. Coupon • This is NOT insurance info. com. 6 NCPDP Version/Release #: D. Medication Formularies 3. Click here for the first page (E3014 - H2001) , second page (H2029 - H3499) , third page (H3517 - H5141) , fourth page (H5163 - H6832) , and fifth page (H6846 - H8998) . PCN and Group are not PCN: Group Number PBM: Phone Number. 015995 GDC DR33 JTV358549. MassHealth’s list of BIN/PCN/ group number combinations for its MCO, ACO, and PCC plans may be found in Appendix A of this document. The Processor Control Numbers (PCN) (Field 1Ø4‐A4) will change to: o “DRTXPROD” for Rx BIN:Rx BIN:Rx BIN:Rx BIN: 003858 Rx PCN:Rx PCN:Rx PCN:Rx PCN: A4 Rx Group #: PHCMRCL Cigna Open Access If you're a provider: Group # and name: Your group number Member ID Cards for Blue Cross Blue Shield of Massachusetts plans . The PCN is changing to CTRXMEDD. BIN and PCN Codes. MCAIDADV. RelayHealth, CMS Transaction Facilitator Presentations and References 201212 January 2012 SPAP/ADAP Supplemental Claims Data Review presentation 201504 Supplemental Payer N Transaction Reports Supplemental Payer Batch N Transaction Information BIN – 025417 . Present this coupon card to the pharmacist when filling or refilling your prescription. The CSHCN Services Program is a separate program from Medicaid and has or RHC must enroll as a group with our program. Medicaid Health Plan BIN, PCN, and Group Information Medicaid Health Plan BIN PCN Group Aetna Better Health of Michigan 610591 ADV RX8826 Blue Cross Complete of Michigan 019595 PRX00621 n/a HAP CareSource 003858 MA CSHAPMI McLaren Health Plan 017142 ASPROD1 ML108; ML110; ML284; ML329 Meridian Health Plan 003858 MA 2EPA Added BIN/PCN Combination BIN 020107 PCN IRXKS (Effective 1/1/2025) Added BIN/PCN Combination BIN 020107 PCN NY (Effective 1/1/2025) Plan Name/Group Name: All Effective as of: Jan 2Ø25 Payer Sheet Version: 2. . MeridianRx PCN Group ID Line of Business. Plan Name/Group Name: Medi-Cal Rx NEW! BIN*: 022659 NEW! PCN*: 6334225 SB393 Drug Inquiry Pricing Request NEW! BIN*: 022667 NEW! PCN*: 393 *Refer to the BIN/PCN Information table below for the full list of transactions and associated BIN/PCNs. 052017) (ZIP) Medicare Part D Contract Plan BIN PCN Files 2015-2023 (ZIP) Medicare Part D CGDP Calendar - 2023-2028 (PDF) Medicare Coverage Gap Discount Program-Manufacturer's Agreement (05. The BIN number will be preceded by the letters “BIN. For cash paying patients, submit as a primary claim using the VIVITROL Co-pay Savings Card information to IQVIA using BIN 601341. Fill the provided container with . 10/01/2024 Page 4 of 26 PART 1: GENERAL INFORMATION Payer/Processor Name: CVS Caremark® Plan Name/Group Name: All Effective as of: October 2Ø24 Payer Sheet Version: 2. PCN and Group are not required. Obtain coverage The Rx BIN number is a 6-digit number health plans use to process electronic pharmacy claims. The GRP, in The Bank Information Number (BIN) (Field 1Ø1‐A1) will change to “61ØØ84” for all claims. Price Lookup Tool. If Commercial The RX BIN number is most often located in the lower left corner of the card along with your Medicare ID number, processor control number (PCN) and group ID number. 888-479-2000 -886 5822 Chapters Health . o “DRTXPRODKH” for KHC claims. 16 ounces of water (up to the fill line). Provider: Dual Member Cost share should be verified and (HMO D-SNP) Amerigroup Texas, Inc. 5 NCPDP Version/Release #: D. Reply reply labcscamper11923 These documents were created by the industry to address a Centers for Medicare and Medicaid Services (CMS) directive entitled “Clarification of Unique BIN (or BIN/PCN) Requirements as of January 1, 2012 [§423. 008878 . 5. PBM. The user identification number should be the cardholders 10-digit phone number. 1, 2020, pharmacies may continue using members’ plan-specific enrollment cards to verify eligibility. 0 January 1, 2019 017142 ASPROD1 ML110 Medicaid D. 0. To adjudicate a claim, you need to enter the Hippo member ID, located on the Hippo savings card, and our BIN number. dhcs. Tips & Disclaimers. Accountable Care Partnership Plans PBM BIN PCN Group Pharmacy Help Desk Be Healthy Partnership (HNE) OptumRx . 2018) (PDF) Coverage Gap Discount Program - Timely Payment Determination (PDF) Plan Name/Group Name: All NCPDP ECL Version: Oct 2019 Processor: RxLogic Software NCPDP ECL Emergency Version: Jan 2019 Effective as of: 01/01/2022 stated in BIN/PCN table 109-A9 TRANSACTION COUNT 1= One occurrence M Maximum of 1 transaction per transmission 202-B2 SERVICE PROVIDER QUALIFIER 01= National Pharmacy Benefit Administrator, BIN, PCN, Group, and telephone number Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark Phone: 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX8810 • If the E1 query returns BIN/PCN, submit the claim to that Medicare Part D plan. Their prescription medications will be covered by a new Ancira Auto Group MaxorPlus Texas 005377 10000019 800-687-0707 Plan Name / Network Name PBM/ Processor Region BIN PCN/ Group Help Desk Anderson Corporation BIN 11529 PCN P022011529 GROUP KY Medicaid Single PBM Magellan Kentucky Medicaid Bin/PCN/Group Numbers Effective 7/1/2021 023880 KYPROD1 KYM01 MedImpact. Express Scripts. Click here for the first page (E3014 - H2001) , second page (H2029 - H3499) , fourth page (H5163 - H6832) , fifth page (H6846 - H8998) , and sixth page (H9001 - X0001) . California (Northern CA) 11842 NCCMS: NC 94-1340523: P. Click here for the first page (E3014 - H2001) , third page (H3517 - H5141) , fourth page (H5163 - H6832) , fifth page (H6846 - H8998) , and sixth page (H9001 - X0001) . input 024350 for BIN/PCN/GRP for all of them. For questions regarding claims, call 800-222-3986. BIN#: 610020 PCN#: PDM or PDMI Forms To Submit 2. GroupID – CSHCN . Box 7012 : Downey, CA 90242: California (Southern CA) 11172: SCCMS SC: 94 . If you have the right numbers, your care will be covered. They will provide all of the necessary information so the pharmacy can bill appropriately. GOV; Receive Update: Listserv Sign Up; BIN 020545 PAYER SHEET REFERENCE KEY The following are the mandatory fields required to process a claim . Some plans use the PCP Focus network, BCN’s tailored PCP network. CNRX. 2 REVERSALS OF COB CLAIMS These should be Plan Name/Group Name: BIN: PCN: Plan Name/Group Name: BIN: PCN: Plan Name/Group Name: BIN: PCN: Processor: SS&C Health Effective as of: 09/21/2020 NCPDP Telecommunication Standard Version/Release #: D. Ø NCPDP ECL Version: Oct 2Ø18 NCPDP Emergency ECL Version: The Bank Information Number (BIN) (Field 1Ø1‐A1) will change to “61ØØ84” for all claims. AHCCCS FFS; 001553; AZM OptumRx: 855-577-6310 AHCCCS FFS – Secondary to Commercial 001553 AZM OptumRx; Pharmacy Claims Plan Name/Group Name: All Effective as of: October 2Ø19 Payer Sheet Version: 1. 3Ø3 BIN PCN Phone Number 610830 REALRXHU 855. 6. Author: jessica. If you have any questions please call our Pharmacy Help Center at 1-855-707-8380. Corporate Headquarters: Monday - Friday 8:30am - 5:00pm EST USA; Pharmacy Help Desk: The chart below is the fourth page of the 2024 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H5163 through H6832. Group numbers and member ID’s do not have to change in the pharmacies system. Download the MyBlue Member Ask the pharmacist to submit your claim to LI NET using the following: BIN:015599 PCN: 05440000 Note: If you have additional questions, call the LI NET help desk at 800-783 The Rx BIN # 610014 The PCN is MEDDPRIME The Rx Group number as listed below The member's ID number (format listed below) Note: Medco anticipates members will have their Product. AZM OptumRx United Healthcare Community Plan (Acute, CRS, DD, LTC) 610494: 4100; ACUAZ OptumRx BIN, Processor Control Number, and Group ID. Please note, the data Check member eligibility in real time using existing pharmacy management system workflows and improve your workflow with automatic inquiries for new prescriptions. 0 Segment Field Value Service Provider ID (201-B1) The Type 2 NPI for the pharmacy contracted for COVID-19 test services should Use the following BIN/PCN when submitting excluded drug claims for MO HealthNet only participants: 004047/43-1754897 What is MORx's group ID? A group ID number is not required. Gentiva 008878 WDRX 888RWTGENTIV 888-479-2000 -886 5822 One Call Medical : 008878 . The items highlighted in the payer sheet BIN/PCN Table . Plan Name/Group Name BIN PCN Legacy ESI Medicaid ØØ3858 A4 (or as assigned by ESI) SC (Use when secondary to Medicare Part D only) MA (refer to The agency noted several potential tools that could be used by MCOs, including requiring covered entities to submit identifiers for 340B claims and assigning a unique Bank Identification BIN PCN Group Member ID. 0 Transaction Code: B1 & B2. 11. X630694700091 Members: Present BIN 610315 PAYER SHEET REFERENCE KEY The following are the mandatory fields required to process a claim Processing a Retail Claim PCN RXGROUP/ GROUP ID PHARMACY HELPDESK PHONE MEMBER SERVICES PHONE Premera/Amazon 4/1/2020 N/A RXA279 Amazon2 800-991-3149 800-991-3164 Minnesota Health Care Programs providers billing for prescriptions for members in managed care organizations (MCOs) need to use the MCO's identification bin and PCN information. What is a specialty drug? A specialty drug is a medication created to target and treat complex medical conditions and rare diseases. 888 -886 5822 Gritman : 008878 . 1. Ø NCPDP ECL Version: Oct 2Ø23 NCPDP Submitted Group (Group) TennCare N/A New Member ID Format 14 Digits Person Code Required No BIN: 001553 PCN: CVRX All members of CoverRx will receive a new member identification (ID) card as shown below. Click here for the first page (E3014 - H2001) , second page (H2029 - H3499) , third page (H3517 - H5141) , fifth page (H6846 - H8998) , and sixth page (H9001 - X0001) . What we can do for you. If you have questions processing this claim, please don’t hesitate to call our Pharmacy Help line: 888-532-3299. MCO Contractor Contact Information; AHCCCS Pharmacy Email address: AHCCCSPHARMACYDEPT@AZAHCCCS. The following is a summary of our new requirements. 0 S egment Field Value Service Provider ID (201-B1) The Type 2 NPI for the ph armacy contra cted for Added BIN/PCN Combination BIN 025771 PCN IRXCOMAP . PRIOR AUTHORIZATION FORM. Collect your: Complete Universal Claim Form or CMS-1500 form; Corresponding Remittance Advice (RA) or Explanation of Benefit (EOB) statement; 2. • If the E1 query returns a Contract ID and help desk numbers, contact that Medicare Part D plan for the 4Rx data. BIN: 019462; Payer sheets provide data requirements needed to electronically process NCPDP pharmacy claims for each line of business within Capital Rx. Tax Identification Number. Most BCN employer group plans use BCN’s standard HMO provider network. If Commercial claims are submitted for groups that have transitioned with the old BIN or PCN, claims will reject with NCPDP Reject Code 01 (M/I BIN) and 04 (M/I Processor Control The chart below is the third page of the 2024 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3517 through H5141. 610084 drmsprod/ sippi n/a 1-800-884-3222 1-877-537-0722 1-877-537-0720 magnolia health plan-can Update: The 2022 BIN/PCN list has been released. Process prescriptions online using the CoverRx ID card information. Optum Chiropractic PO Box 212 Minneapolis, MN 55440-0212. BIN Information . ca. behavioral health $20. BIN 610591 20107 610649 4336 4336 610494 11529 PCN ADV KY 3191501 MCAIDADV MCAIDADV 4040 P022011529 GROUP RX8831 WKVA RX5035 RX8893 ACUKY KY Medicaid PBM CVS Caremark IngenioRx Humana Pharmacy Solutions CVS Caremark CVS Caremark Optum Rx Magellan Kentucky Medicaid Bin/PCN/Group Numbers Effective Enter BIN number: 003858; Enter processor control: WC; Enter the group number: MEMIC; Enter the injured worker’s nine digit ID number (SSN provided by the injured worker) Enter the injured worker’s first and last name; Enter the injured worker’s date of injury (mm/dd/yyyy) As of January 1, 2021, all Cigna Healthcare SM Commercial pharmacy plans and Cigna Healthcare Medicare claims are adjudicating on the Express Scripts systems. helpdesk - provider pharmacy prior auth. Contact/Information Source: elixirsolutions. 859. Will Aetna reject claims that have been submitted with the Medicare Unique o Due to 4 RX Matching requirements, BIN, PCN, Cardholder Id and Group must be submitted as provided on original PAID claim. fax number medicaid feeforservice . Rx BIN: 020115 Rx PCN: IS Rx GROUP: WM2A Issuer ID: 80840 Member ID: Amerivantage Dual Secure CMS H2593-PBP: 033-000 Most dual eligible members pay $0 for plan covered medical services. Medicaid Families and Children: Rx Bin: 003858 Rx PCN: MA Rx Group: 3Medica. Accountable Care Partnership Plans MCO Partner PBM BIN PCN Group BMC HealthNet Plan The agency noted several potential tools that could be used by MCOs, including requiring covered entities to submit identifiers for 340B claims and assigning a unique Bank Identification Number (BIN)/Processor Control Number (PCN)/Group number to the MCO’s Medicaid line of business and requiring providers to bill 340B claims to that BIN/PCN Program Member ID Required BIN PCN Group Processor/Helpdesk # Amerigroup Member or Medicaid ID 003858 MA WKJA Express Scripts/ 1-844-367-6112 CareSource Member or Medicaid ID 004336 MCAIDADV RX0835 CVS Caremark/ 1-844-441-8024 Peach State Rx Bin: 003858 Rx PCN: MD Rx Group: 2Medica. • This recipient information must be entered exactly as it appears on BIN Information BIN Number Effective as of NCPDP Version 610241 January 1, 2019 D. 003858. Medica Behavioral BIN, Processor Control Number, and Group ID. Member and Pharmacy Help Desk Phone Number: 1-800-424-1664 Pharmacy Prior Authorizations Phone Number: 1-800-424-1664 BIN_PCN_111824 (ZIP) Manufacturer Coverage Gap Discount Guidance (v. Amida Care (877) 354-3439; Express Scripts (800) 824-0898 A4: 003858 Group: KJFA: Blue Cross Blue Shield of Western NY (877) 327-1395; Express Scripts (866) 544-7948 610014; Group: HNRXS. This card valid exclusively at CVS, Target, Longs Drugs, Walmart, Kroger, Fry’s, Harris Teeter, Once our BIN is installed you can process our orders like any other claim. 0 NCPDP Data Dictionary Version Date: Date of Publication NCPDP External Code List 2025 OptumRx BIN 610279 Payer Sheet. No discount card fees. 0 AHCCCS Health Plans BIN PCN Group Number PBM AHCCCS Fee-For-Service 001553 AZM OptumRx AHCCCS FFS – Secondary to Commercial 001553 AZM OptumRx AHCCCS FFS – Dual Eligibles for Covered OTC Prescriptions 001553. Each line of business will have a designated payer sheet for reference when setting up Capital Rx BIN/PCN numbers into the pharmacy system. • If the E1 query returns a telephone number for Contract ID “X0001,” the patient is Commercial, Medicaid and MA Only BIN: 610494 PCN: 9999 Community Health BIN: 610613 PCN: 2417 United Healthcare Community Plan of Indiana BIN: 610494 PCN: 4841 3Ø1-C1 GROUP ID M Always required. Please use the following information when submitting claims for Superior HealthPlan Medicaid members. jump Created Date: Following are billing instructions for the Medicaid Plans: BIN: 004336, PCN: MCAIDADV GRP: RX0546, RX6422, RX6423 Following are billing instructions for the Essential Plans: BIN: 004336, PCN: ADV GRP: RX6424 NCPDP D. Refer to Member ID Card. 2024 Medication Formulary Is My Pharmacy Contracted? 4. This document Bin: 004336; PCN: ADV; Group: RX22MA; With the MyBlue Member App, you can also find a doctor, review claims, and keep track of your prescriptions. 3Ø3 Rx BIN (Benefit Identification Number) Rx PCN (Processor Control Number) Rx group. BIN Number Effective as of NCPDP Version 610241. MA. Medicaid Health Plan BIN, PCN, and Group Information Medicaid Health Plan BIN PCN Group Aetna Better Health of Michigan 610591 ADV RX8826 Blue Cross Complete of Michigan 019595 PRX00621 n/a HAP CareSource 003858 MA CSHAPMI McLaren Health Plan 017142 ASPROD1 ML108; ML110; ML284; ML329 Meridian Health Plan 003858 MA 2EPA Pharmacy Claims BIN PCN RX Group IHCP Fee-for-Service 1-855-577-6317 OptumRx 1-855-577-6317 1-855-577-6317 001553 INM Not required Anthem Healthy Indiana Plan (HIP) Hoosier Care Connect (HCC) Hoosier Healthwise (HHW) 1-866-408-6131 (HIP & HHW) 1-844-284-1797 (HCC) 1-866-408-7188 (TTY) Express Scripts, PLAN BIN PCN Group Note: The Submitted Group code varies. Click here for the first page (E0654 - H1997) , second page (H2001 - H3563) , third page (H3572 - H5325) , fifth page (H7323 - H9686) and sixth page (H9699 - S9701) . Mandatory Insurer Reporting for Group Health Plans (GHP) Mandatory insurer reporting (NGHP) Workers' comp Medicare set aside arrangements; Attorney services; Beneficiary services; Clarification of Unique BIN (or BIN/PCN) Requirements as of January 1, 2012 (v. bc/bs plan code 280/780. Plan Name/Group Name BIN PCN Legacy ESI Commercial ØØ3858 A4 (or as assigned by ESI) SC (When secondary to Medicare Part D only) Legacy Medco Commercial The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2024 Medicare Part D plan sponsor. Thank you for taking the time to provide these customers with savings on BIN Number PCN Group Number(s) Alliance Navitus 610602 MCD Medicaid: TPMC NCHC: TPHC Partners CVS Caremark 025052 MCAIDADV RX22AC Trillium Perform Rx 019595 PRX10811 N/A Vaya Navitus 610602 MCD VAYARX . Chiropractic Care . 008878 : WDRX . The Processor Control Numbers (PCN) (Field 1Ø4‐A4) will change to: o “DRTXPROD” for Medicaid, CHIP, and CSHCN claims. BIN PCN Group Member ID. outpatient hospital $30. express-scripts. The PDF417 image, if printed, must be printed as the uppermost item on the back BIN Number: 025986 Version/Release #: D. bin (banking info #) number pcn (processor control #) group id pharmacy pos claims helpdesk prior auth. • This recipient information must be entered exactly as it appears on BIN: 610279 PCN: 9999 GROUP: UNEVADA. 888-479-2000 : 888-886-5822 . 0 017076 January 1, 2019 D. 0 NCPDP Data Dictionary Version Date: July, 2007 NCPDP External Code List Version Date: March, 2010 2020 OptumRx BIN 610279 Payer Sheet. Group and Member ID numbers will remain the same. If you have any questions about this please call the Hippo pharmacy help center at 1-855-707-8380. BIN: 610378 PCN: SC1 Group: 2060 Member ID: 100126 THIS CARD IS NOT INSURANCE SAVE UP TO 80% on prescription drugs at virtually All Major Pharmacies! Brought to you by in partnership with Clever RX. 610593 : MHP : HNEMH (800) 918-7545 (Optum Rx) Berkshire Fallon Health Collaborative CVS Caremark ; After Jan. Plan Name/Group Name: All NCPDP ECL Version: Oct 2019 Processor: RxLogic Software NCPDP ECL Emergency Version: Jan 2019 Effective as of: 01/01/2022 stated in BIN/PCN table 109-A9 TRANSACTION COUNT 1= One occurrence M Maximum of 1 transaction per transmission 202-B2 SERVICE PROVIDER QUALIFIER 01= National The chart below is the sixth page of the 2024 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H9001 through X0001. 9999 8888 610097 610097 COS Local 436 Local 400 IBT TEAMStar Teamsters Misc. For pharmacy support, please reference the Pharmacy Help Desk phone number on the member’s ID card. 10) Get email updates. January 1, 2019 D. Click here for the first page (E0654 - H1997), second page (H2001 - H3563), third page (H3572 - H5325), fourth page (H5337 - H7322), fifth page (H7323 - H9686) and sixth page (H9699 - S9701). The help desk is open 24/7, 365 days a year. Specialty drugs are designated on your plan The chart below is the second page of the 2024 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H2029 through H3499. Copayments TX CHIP only: TX CHIP00 $3 Brand/$0 Generic TXCHIP01 $5 Brand/$0Generic TXCHIP02 $35 Brand/$10 Generic This is where we begin to explain what Rx, BIN, PCN, GRP mean. Rx ID: billed to member's Medicaid. • If the E1 query returns BIN/PCN, submit the claim to that Medicare Part D plan. RXA381 : RXGMPGA01 . BIN PCN Group; 022659: 6334225: Medi-CalRx: Medi-Cal Rx Customer Service Center 1(800)-977-2273 https://www. 0 January 1, 2019 017142 ASPROD1 ML109 Medicaid D. Group will be Rx and then 4 digits Reply reply That might just be the medical card. Group ID 123456789012345. Using the Payer Sheet Template Implementation Guide The BIN/IIN and PCNs are listed on the PBM/processor/plan’s Payer Sheets for trading partners to know the proper identifiers for routing transactions. Corporate Headquarters: Monday - Friday 8:30am - 5:00pm EST USA; Pharmacy Help Desk: Your RX Group is used by your pharmacy to process your prescription benefit; Your BIN or bank identification number tells your pharmacy that you are covered by Blue Cross and Blue Shield of Vermont. This symbol is important when providing healthcare services to out- of-area patients. Please use the following information when submitting claims for Centene Medicare members. The Expo Rx Prescription Savings Card's price look-up tool on ABC Order provides instant access to pricing and complete visibility into copays that compare favorably to pharmacy chains in your area. The GRP, in short, is the group number given by insurance companies to identify a member’s group health plan. Once our BIN is installed you can process our orders like any other claim. com The Rx BIN # 610014 The PCN is MEDDPRIME The Rx Group number as listed below The member's ID number (format listed below) Note: Medco anticipates members will have their newly issued ID cards, but to assist members and pharmacy in the event that not every member has the new ID card, Medco is supplying members of the enhanced Without these codes Prior to submitting a new claim, please adjust the BIN and PCN on the copay savings offer to 019158 and CNRX. 5 “Account” In the pharmacy industry, the BIN number may represent the address of a large computer and the PCN 1234567890 . I AM UNABLE TO FILL A PRESCRIPTION AT THE PHARMACY BECAUSE I AM SHOWING NOT ELIGIBLE. 120(c)(4) as revised by CMS-4085-F]” which was released on November 12, 2010 that provided clarification of Unique BIN (or BIN/PCN BIN/PCN/Group Numbers for ACOs, MCOs and PCC Plan The three tables below shows the correct combinations effective March 1, 2018, for pharmacies to use when submitting MassHealth ACO/MCO/FFS pharmacy claims. D. AlphaScrip Florida Health Administrators This is where we begin to explain what Rx, BIN, PCN, GRP mean. AHCCCS FFS 001553 AZM OptumRx 855-577-6310 AHCCCS FFS – Secondary to Commercial 001553; AZM; Pharmacy Claims Processing BINs, PCNs and Group Numbers – Acute Care Plans. 800-868-3982 : Ambetter from Illinicare Health, BIN/PCN/group number combinations are provided on these cards. 0 Segment Field Value Service Provider ID (201-B1) The Type 2 NPI for the pharmacy contracted for COVID-19 test services should Following are billing instructions for the Affinity by Molina Healthcare Essential Plans: BIN: 004336, PCN: ADV GRP: RX21DF NCPDP D. Share: Share on LinkedIn Share on Facebook Share on Twitter Share on Pinterest Share via Email Print. 987654321 987654321 987654321 987654321 Member Name: JOHN Q SAMPLEMEMBER JANE M P SAMPLEMEMBER JOAN M SAMPLE-MEMBER JAKE L SAMPLE-MEMBER ER Co-pay $200 Pharmacists: 1-800-865-8715 ANSI BIN # 610649 PCN # 03190000 Ofc Visit Co—pay And you can still add the card BIN, PCN, group number, and any patient ID to a patient’s profile at any time. Swallow each tablet with a sip of water, and drink the entire amount of water over 15 to 20 minutes. These numbers are required for pharmacy claims processing. Ø NCPDP Data Dictionary Version Date: July 2ØØ7 NCPDP External Code List Version Date: July 2Ø13 Contact/Information Source: 1-877-782-5565 BIN#: 610020 PCN#: PDM or PDMI Forms To Submit 2. The same group number and member ID will be utilized when submitting the claim through SS&C Medicaid Unique BIN_PCN RX BIN Number RX PCN RX Group Line of Business NCPDP Version Effective as of 017142 ASPROD1 ML108 Medicaid D. BAPMCORX N/A Commercial CMEMCORX N/A Commercial QCPRX N/A Commercial COMRXGRP MEDAVISION Commercial RXCOMP Refer to Member ID Card Commercial. You can BIN: 015581 PCN:03200000 Plan Name/Group Name: Humana/ MA Part B Plans (MA only) BIN: 610649 PCN: 03200004 Plan Name/Group Name: BIN: PCN: Plan Name/Group Name: BIN: PCN: Processor: SS&C Health Effective as of: 09/21/2020 NCPDP Telecommunication Standard Version/Release #: D. 2) Provide pharmacy with BIN, PCN, Group, Member ID from copay card *If E-Scribing, type the above info into “DRUG INSTRUCTIONS” section 3) If the patient’s SUTAB prescription is not covered, tell pharmacy to process this copay card with their rejection from insurance as a Coordination of benefits (COB) to receive the $40 copay Plan PBM Phone BIN PCN Group OHA (Fee -for-Service or “Open Card”) 888-202-2126 014203 ORDHSFFS Advanced Health 800-788-2949 003585 38900 AllCare 800-788-2949 003585 38060 Cascade Health Alliance 800-788-2949 003585 38960 Columbia Pacific CCO 866-843-5126 610011 IRX CORMCAID BIN/PCN—Submit the claim to the plan indicated; and the 4Rx data below: BIN: 015599 PCN: 005440000 Group ID: May be left blank Cardholder ID: Medicare claim number (include letters) Optional field: Patient ID: Medicaid ID or Social Security number; Helpful LI NET resources for pharmacists BIN: 020099 PCN: WG Group WLHA If that does not resolve the issue, ask the pharmacy to call CarelonRx at 844 -721 0409. Authorizations – Optum: 1-800-873-4575. 716184N : 888-479-2000 . 0 Processor Control #: 1214172240 Group ID: LAMCOPBM All submitted fields will be edited for valid format and values. Group ID: Program Group Numeric Identifier Medical Access Program (MAP): 53210000 MAP BASIC: 53230000 MAP BASIC Dental-only: 53220000. primary care $5. PLAN NAME / GROUP NAME BIN PCN WellDyne - Various 023252 WCH, WDN (BIN: 008878) CHRX ChicagoRx Card / WellCardRx 020586 WDN or as appears on ID card Pharmastrategies 014856 Not required Pharmastrategies 015383 Not required Pharmastrategies 016359 Not required RxMedSaver 018034 WDF or as appears on ID card Plan Name Bin PCN Rx Group Care1st 003858 MA 2DVA Care1st Behavioral Health 003858 MA 2DVA Care1st Dual MA003858 2DVA Care1st Dual-LICS 003858 MA 2DVA Sample ID Card If you need a member’s specific prescription processing information or other help with a claim, please visit our Pharmacist Resource Center at https://prc. Quick Links to NC Medicaid Pharmacy Services. Rx BIN. Ambetter from Peach State Health Plan GA . This document provides information on electronic claims processing, Each pharmacy will need to have the BIN/PCN previously used to submit to Change Healthcare realigned to the following BIN / PCN combination: RxBIN – 019158 PCN – CNRX . BIN 014889. Rx BIN and PCN numbers are used by new members to pick up a new prescription (or refill) Beginning January 1, 2015, please submit all Part D claims with the appropriate Bank Identification Number (BIN), Processor Control Number (PCN) and Submitted Group (Group) Submit a query to Medicare’s online eligibility query system. Rx group # and BIN# These numbers relate to pharmacy claims. 00. Medi-Cal Rx Provider Portal. Click here for the first page (E0654 - H2235) , second page (H2237 - H3959) , fourth page (H5928 - H8634) and fifth page (H8634 - S9701) . 0 NCPDP Data Dictionary Version Date: July, 2024 NCPDP External group number 30-85343. emergency room $35. Rx PCN. PDF417 Image Placement . Keep your KHC client identification ready when calling. For more information about our plans and The chart below is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3962 through H5928. 12. vlrnimylsdemkxhnpkndvczsnqmrygfcawrmkrsuyfwjyomw