Iowa Admin. Code r. 191-78.2
"Administrator" or "administrator of the payor" means the claims administrator or administrators to which claims for prescription drug benefits are submitted, processed and adjudicated, and includes pharmacy benefit managers, and excludes administrators for self-funded employer-sponsored health benefit plans qualified under the federal Employee Retirement Income Security Act of 1974.
"BIN number," "IIN/BIN number," "BIN," or "RxBIN" means the ANSI-assigned issuer identification number, or IIN, which was formerly known as the "bank identification number" or "BIN," and which is identified in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide as the "BIN number." The "Rx" prefix is not required if the same BIN number is used for pharmacy and medical claims submission.
"Card" or "card or other technology for claims processing" means a card or other technology that is issued to insureds, enrollees, and covered individuals. Insureds, enrollees, and covered individuals provide the card to pharmacies to receive prescription drug benefits. Pharmacies use the information, required by Iowa Code chapter 514L to be on the card, for prescription drug claims submission, processing and adjudication with providers, administrators, pharmacy benefit managers or similar entities.
"Cardholder ID" means the cardholder's unique identification number that is issued by the provider to the insured, enrollee, or covered individual, and which is identified in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide.
"Cardholder name" means the cardholder's first name, middle initial and last name.
"Card issuer identifier number" means the number identified in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide as the international identifier for the United States of America, which has not yet been enumerated and may remain blank on cards until such number is determined.
"Card issuer's name and logo" means the name and identifying mark of the entity issuing the card or other technology, identified in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide.
"Consistent with the guide" means that the information and data elements on the card shall conform to the standards set forth in the most recent release of the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide, except that the address of the pharmacy benefit manager may be excluded and the information and data elements may be placed at different locations on the card as reasonably necessary to accommodate space and logistical needs.
"Group ID number, " "Grp," or "RxGrp" means the group identification number or group ID number as identified in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide. The "Rx" prefix is not required if the same group number is used for pharmacy and medical claims submission.
"Guide" or "National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide" means the most recent document issued by the National Council for Prescription Drug Programs.
"Pharmacy benefit manager" means an entity that receives and processes claims for payment or prepayment for prescription drug expenses from pharmacies and that may issue cards or other technology for prescription claims processing.
"Processor control number," "PCN, "or "RxPCN" means the processor control number as identified in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide. The "Rx" prefix is not required if the same PCN number is used for pharmacy and medical claims submission.
"Provider of third-party payment or prepayment of prescription drug expenses" or "provider" means a provider of an individual or group policy of accident or health insurance or an individual or group hospital or health care service contract issued pursuant to Iowa Code chapter 509, 514 or 514A, a provider of a plan established pursuant to Iowa Code chapter 509A for public employees, a provider of an individual or group health maintenance organization contract issued and regulated under Iowa Code chapter 514B, a provider of a preferred provider contract issued pursuant to Iowa Code chapter 514F, a provider of a self-insured multiple employer welfare arrangement, and any other entity providing health insurance or health benefits which provide for payment or prepayment of prescription drug expenses coverage subject to state insurance regulation.
"Substantially consistent with the guide" means that the location of the uniform prescription drug information on the card or other technology shall conform to the standards set forth in the most recent National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide. The information may be placed at different locations on the card as reasonably necessary to accommodate space and logistical needs.
"Uniform prescription drug information" means the requirements set forth in the most recent National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide, including the data elements information required on the card, such as the content, format and the location.
Iowa Admin. Code r. 191-78.2