Frequently Asked Questions

Understanding BIN, PCN, and GROUP Numbers

What is a BIN number?

A BIN number (Bank Identification Number) is a six-digit number that identifies the issuer of a health insurance card, typically a health plan or a Pharmacy Benefit Manager (PBM). It's used to route pharmacy claims to the correct payer for processing.

What is a PCN number?

A PCN number (Processor Control Number) is a secondary identifier that provides more specific information about a particular plan or benefit package within a health plan. It helps differentiate between various plans administered by a PBM.

What is a GROUP number?

A GROUP number is a tertiary identifier that pinpoints the exact group or sub-plan within a health plan. It's defined by the PBM and is unique to their business needs.

Where can I find the BIN, PCN, and GROUP numbers on an insurance card?

These numbers are usually printed on the patient's insurance card, but the location and format can vary depending on the plan.

Troubleshooting

What should I do if the BIN, PCN, or GROUP number is missing or I can't find the RxBIN, RxPCN, or RxGroup number on the card?

If any of these numbers are missing, contact the insurance company directly. For most pharmacy cards, the Member ID and RxBIN are the most important pieces of information to provide to a pharmacy. Providing the RxGroup and RxPCN can help the pharmacy find your health insurance information faster and more accurately. If you only have a medical insurance card and need to find your pharmacy benefits information, you can contact your insurance company for this information.

What should I do if a pharmacy claim is rejected?

Carefully review the rejection reason, correct any errors, and resubmit the claim with the necessary documentation.

Claims Processing

What are Submission Clarification Codes (SCCs)?

SCCs are numeric codes used by pharmacies to provide extra information about a claim, such as the reason for an early refill or to clarify medical necessity.

What are some common reasons for pharmacy claim rejections?

Common reasons include incorrect patient information, invalid or missing codes, and failure to meet prior authorization requirements.

Getting Help

For additional support or questions not covered here, please contact our support team through the contact page.