PCN# vs. RXBin# vs Condor Codes

[Guest guest]

Hey Everybody!

Sorry That I have not even been a 'lurker' in the past couple of

weeks but I really jusy needed to take some 'time off' from my

postings to both Jeanetta and Joe's Groups.

After I took my my PCAT, I came doen with some sort of illness that

reaked havok with my upper respiratory system, and pretty much put me

down.

If it was not for the fact that I had to help prepare for yearly

inventory...

Well, that's a different story.

Sometimes you have to 'work through your illness'!

As I posted earlier, a Tri-Pak and Medrol got me through it!

Jeanetta, I only have experience procesing insurance claims using the

Condor System at CVS.

As I have posted earler, 'Drop Off' is really the hardest part of the

job in Retail.

A classroom lesson could help to prepare your students for this.

But it seems that Pharmacy chains process claims differently.

I will give you (AN EXAMPLE) of my curent BC/BS of Texas insurance

card:

Subscriber: ES***R M (She still uses her maiden name)

Idenification #ZGP887353526 (NOT REALLY OF COURSE! JUST AN EXAMPLE!)

Group # 0097004

Coverage Date: 01-01-07

NETWORK: PTXOA

ON THE BACK OF THE CARD:

RxBin 011552

RxPCN BCTX

My 'proper name' is Christian Bowen Oliver.

My wife' 'maiden name' is E. Michele .

My Step Daughter's name is Felicia M. Cook.

But this card covers ALL OF US.

At CVS, I use Condor Code 8543 which is what you use ONLY for BC/BS

of TEXAS!

There are other Condor Codes for other BC/BS insurance cards that you

have to 'find' by searching using either the BIN# or the PCN#.

As you continue to input a patient's profile, you must be sure

to 'make them' male or female, have their 'proper' DOB (WHICH REALLY

MIGHT NOT BE THE ACTUAL DAY THAT THEY WERE BORN BUT WHAT THEIR

INSURANCE HAS AS THE DOB. I HAVE CALLED THE INS COMPANIES SEVERAL

TIMES AND BEEN TOLD THAT I HAVE 'REJECTIONS' BECAUSE THE DOB THAT

THEY HAVE ON FILE FOR A PATIENT IS NOT THE SAME THAT I HAVE BEEN TOLD

WHEN A CUSTOMER IS STANDING RIGHT IN FRONT OF ME!!!! MAKES FOR AN

INTERESTING CONVERSATION!!!)

And you also must make sure that you input the proper numbers into

your computer system!

As I have stated before, with BC/BS cards, NEVER input ANY LETTERS

that come before the first numbers.

For example:

If the card has SSD4656474656, then for the member number you only

put 465647656 into the computer as the MEMBER number.

On the other hand if the card has something like:

445AGDP011

THEN you input the letters as well....

Seems complicated, but it really is not once you 'learn the ropes'...

AND THAT'S JUST BC/BS!!!!!

I'd like to see what happens to a 'novice' Tech. when he/she is is

trying to 'figure out' how to submit a Medicare Part D plan...

Jeanetta, I don't know if I could actually write a 'Lesson Plan' that

you could use for your students.

But all things considered, especially how much you have helped me to

become the professional that I am now:

I would be glad to help in any way that I can because pulling stock

bottles from the shelf, counting, pouring, labeling, even

compounding, is REALLY SIMPLE compared to having to deal with 'DROP-

OFF'....

Also a a really neat 'footnote'...

I got my Letter of Acceptance today!

I guess A & M got my PCAT score before I did!

Thank you so much for everything that you have given to me!

My customers in the Coastal Bend Region of Texas will benefit from

all of the knowlege that you, Joe, and all of the Group members have

given to me through all of our discussions over the past two years!

Gratius et valoram meastrus intelligenciam!

Christian B. Oliver CPhT