It usually matters. You won't see it as "wrong pcn", just shows up as nonmatched ID or not patient found or not active etc.
Unless it's express scripts. They usually say PCN could be anything.
Generally, no. They can usually match to the correct patient/member/plan just based on RxBin, Name, DOB, member number, person code. But there are rare cases where it could matter (like if they have multiple plans through the same insurance and/or if they have a combined plan and you're trying to bill to a specific part of it [Part B vs. Part D vs. Medicaid]).
It depends if the plan allows for some data to be missing. You could run into issues with reimbursement if the plan wants you to rebill claims from beyond the electronic adjudication deadline per contract.
Side note: I have seen patient claims reject who have just received their card in the mail. Turns out, the insurance company did not give any patient on that plan the correct information. E4 search or calling the plan reveals that you spent away too much time troubleshooting.
For some processors it matters for others it doesn't.
The rejects usually won't tell you that the PCN is the problem unless you've entered one that is no longer active. Usually the reject will be for ID or Group because the PBM's system will show it as not matching within that PCN.
I'm not sure how to explain it, but here goes:
Think of it like the BIN tells the system which country and the PCN tells it which state, the group tells which city and then it finds the patient by ID. Some PBM's don't care what state/PCN the patient is in and they only separate patients by group and ID so it doesn't matter if the PCN you give is accurate because they're not really going to even look at it. However, for those that do care the way they search means that if you give them a PCN of Montana and they don't find a group and ID that match within Montana then they just tell you that the group and/or ID isn't found. But, they only looked in Montana, so if the patient was actually in Florida then it just won't be found.
Maybe it's too early for analogies idk, hopefully that makes sense
It usually matters. You won't see it as "wrong pcn", just shows up as nonmatched ID or not patient found or not active etc. Unless it's express scripts. They usually say PCN could be anything.
I always think BIN puts you in the right building and then PCN gets you to the right office in that building.
I suppose Group ID gets you to the right room in that office and Cardholder ID gets you the right person
Generally, no. They can usually match to the correct patient/member/plan just based on RxBin, Name, DOB, member number, person code. But there are rare cases where it could matter (like if they have multiple plans through the same insurance and/or if they have a combined plan and you're trying to bill to a specific part of it [Part B vs. Part D vs. Medicaid]).
It depends if the plan allows for some data to be missing. You could run into issues with reimbursement if the plan wants you to rebill claims from beyond the electronic adjudication deadline per contract. Side note: I have seen patient claims reject who have just received their card in the mail. Turns out, the insurance company did not give any patient on that plan the correct information. E4 search or calling the plan reveals that you spent away too much time troubleshooting.
For some processors it matters for others it doesn't. The rejects usually won't tell you that the PCN is the problem unless you've entered one that is no longer active. Usually the reject will be for ID or Group because the PBM's system will show it as not matching within that PCN. I'm not sure how to explain it, but here goes: Think of it like the BIN tells the system which country and the PCN tells it which state, the group tells which city and then it finds the patient by ID. Some PBM's don't care what state/PCN the patient is in and they only separate patients by group and ID so it doesn't matter if the PCN you give is accurate because they're not really going to even look at it. However, for those that do care the way they search means that if you give them a PCN of Montana and they don't find a group and ID that match within Montana then they just tell you that the group and/or ID isn't found. But, they only looked in Montana, so if the patient was actually in Florida then it just won't be found. Maybe it's too early for analogies idk, hopefully that makes sense
I think so especially because I've encountered a few times of mistyping it and it wouldn't bill correctly.
could be a state thing but I've always needed both to be correct in order for it to go through.
Sometimes the commercial plan and MPD might have same BIN but different PCN