Which items constitute required insurance information for drug claims?

• A. Group number, Member ID, Card issuer Id, RxBIN, RxPCN
• B. Date of birth, address, phone
• C. NDC, DAW, days supply
• D. Prescriber ID, Pharmacy ID

Answer: (A)

The essential pieces are the identifiers that direct a claim to the correct payer and plan. The group number links the patient to a specific employer or plan group, the member ID uniquely identifies the patient within that plan, the card issuer ID identifies the payer issuing the insurance card, and the RxBIN and RxPCN work with the pharmacy benefits manager to route the claim and determine benefits. Together, these elements ensure the claim is processed under the correct coverage and benefit rules. Patient demographics like date of birth, address, and phone are used for verification but not for routing claims. Drug specifics such as NDC, DAW, and days’ supply relate to the product and dispensing details, not the payer routing. Prescriber ID and Pharmacy ID identify the provider and place of dispensing but aren’t the insurance routing keys.