Question

a patient presents to the pharmacy with a prescription drug card to get a prescription refilled. which of the following identifies the patient as the primary, spouse, or dependent on the insurance plan?

group code
person code
pcn number
identification (id) number

Explanation:

Analyze the insurance card fields

In Pharmacy Billing, several key identifiers are found on a patient's prescription drug card to route and process claims correctly:

• Group code: Identifies the specific employer group or plan benefits.
• PCN (Processor Control Number): A secondary identifier used by the insurance processor to route the claim.
• Identification (ID) number: Unique number assigned to the primary policyholder.

Identify the relationship code

To distinguish between different individuals covered under the same family plan (such as the primary cardholder, spouse, or dependents), a specific code is used. This is known as the Person Code (or relationship cardholder code). Typically:

• 01 represents the primary cardholder.
• 02 represents the spouse.
• 03 and subsequent numbers represent dependents.

Answer:

• Group code
• Person code (Correct answer)
• PCN number
• Identification (ID) number