What Is A Processor Control Number On A Health Insurance Card?

A processor control number (PCN) is a secondary identifier used in routing pharmacy transactions. The number could be alphanumeric or strictly numeric, as defined by the pharmacy benefits manager. You can find your PCN on your health insurance card alongside other numbers such as your Bank Identification Number (BIN), Member ID, and plan type.

In the late 80s, the pharmaceutical sector began processing insurance claims electronically. This new system meant that the pharmacy benefit manager needed to route transactions. This need led to the creation of the bank identification number.

More identifiers for routing transactions, such as the processor control number and the Rxgrp number, were developed to simplify the process.

Use Of A Processor Control Number 

As we mentioned earlier, the most crucial function of a processor control number(PCN) is to route pharmacy reimbursements transactions for health insurers.

What this means is that with your processor control number, your member profile can be located under a pharmacy benefits manager, and this allows you to enjoy drug benefits.

If you’re wondering, a pharmacy benefits manager is a company that provides and manages prescription drug benefits for your health insurer.

In essence, they are the middleman between drug manufacturers and your insurance company, and they play a significant role in ensuring drugs are more accessible and affordable for insurance users.

Another possible use for processor control numbers is that a Plan Benefits Manager may use them in differentiating different plans and benefits packages.

Insurance providers usually have different coverages that come at different prices, so it makes sense that each plan would cover a list of drugs that differ from each other.

With a Processor Control Number, it would be easier for the Plan Benefits Manager and your insurance provider to differentiate their available benefit packages.

Note that not all companies use a processor control number for this purpose. They may choose to use another number, such as a group ID, to differentiate their plans. Some businesses may not even separate their plans at all.

Where to Find Your Processor Control Number

You can find your processor control number on your health insurance ID card alongside other essential information such as your subscriber number, group number, and plan name.

Your processor control number should be labeled as RxPCN followed by a series of alphanumeric or numeric values.

If you cannot identify your processor control number from your health insurance card, it would be helpful to reach out to your insurance provider for further assistance.

Another tip for locating your processor control number is usually grouped with your bank identification number, group number, and plan type.

Other Information Used For Transaction Routing 

Bank Identification Number (BIN) 

Remember that your processor control number is a secondary means of routing your pharmacy transactions.

The primary number used in confirming what company will reimburse the pharmacy for the cost of your prescription is the bank identification number.

While the number helps to identify what bank issues a card, in the medical field, a bank identification number has nothing to do with banks. When filling out your prescription, you will be required to provide your bank identification number.

Like we mentioned earlier, this number is used to determine which insurance provider will pay for your claim on prescription at a pharmacy.

Note that the bank identification number is no longer supported, and it is now referred to as an Issuer Identification Number (IIN).

To obtain an issuer identification number, you would have to contact the American National Standards Institute (ANSI) via their website and follow the instructions given there.

RxGrp 

This is another identifier used that pharmacies use in processing your benefits. It is the last element used in routing transactions according to the NCPDP.

RxGrp is also called a prescription group, and it is displayed as a series of numeric or alphanumeric numbers on the front of your card.

Some insurance providers will group your benefits based on physical benefits, while others may base them on pharmacy benefits. How your benefits are grouped is dependent on your health care plan.

Not all insurance companies provide this information on your health insurance card, and it may not always be necessary to provide it. If you need it, you should contact your health insurance company.

Additional Information On Your Health Insurance Card 

Plan Names 

Your plan name is the name of your insurance plan or coverage from your insurance provider. Usually, this is displayed at the top of your insurance card. The most common names for insurance plans are Cigna, Aetema, Kaiser, and Humana.

Rx 

The Rx symbol is a pointer that your insurance company covers either a portion of the total costs on your prescription.

Some companies may place a % or $ sign with a stated number. This will paint a clearer picture of how much of your costs are covered by the insurance company.

We should mention that not all companies will state this on your insurance card. However, if you know about your plan’s copay or coinsurance policy, you may not need this information displayed on your card.

Formulary 

You may not find this on most insurance cards, but if it is on your, you should know what it means. A formulary is a list of medications covered by your insurer.

Sometimes your health insurer will have different formularies for different plans. Usually, each formulary is differentiated using a number; formulary 1, formulary 2, etc.

Conclusion 

Your processor control number forms part of a group of information used in processing your claims by pharmacies.

With either your processor control number, bank identification number, or Rxgrp number, a pharmacy can identify who will reimburse them for the cost of your prescription medication.

You must have this information at your fingertips because processing a claim without them would be very difficult. Fortunately, insurance companies have made it easy to access this information via your insurance card.

If you cannot find this information on your card or you’ve lost it, we advise you to contact your insurance company to reissue you a new card or provide you with the information you need.