- (a) A prescription drug information card shall include in a clear, readable, and understandable manner all information data elements set out in subsection (d) of this section that are necessary to process a claim for prescription drug benefits under the health benefit plan.
- (b) Font size. The font size for the data elements required by this part shall be eight (8) points or greater.
(c) Dates.
- (1) The date of birth, if printed on the ID card, must include the century digits and be in the format mm/dd/ccyy (e.g., 12/14/1960).
- (2) All other dates printed on the ID card must be in the format mm/dd/yy (e.g., 12/14/60), or in the format mm/dd/ccyy.
- (d) Stand-alone prescription drug information cards shall contain the following data elements in the following locations:
| Information Data Element | Location |
| Card Issuer name or logo | Front, top, margin |
| Rx Bank Identification Number [BIN] | Front, left side |
| Processor Control Number | Front, left side (situational) |
| Group ID | Front, left side (situational) |
| Cardholder ID | Front, left side |
| Cardholder Name | Front, left side |
| Claims submission name(s) and address(es) | Back, bottom |
| Help Desk Telephone number(s) | Back, bottom |
- (e) Card issuer name or logo. The card issuer name may be the legal name or the trade name of the issuing health benefit plan.
(f) RX bank identification number.
- (1) The prescription bank identification number (BIN) is utilized in the electronic routing of pharmacy claims.
- (2) The American National Standards Institute, 11 West 42nd Street, New York, NY 10036, (212) 642-4900, assigns a BIN to each processor.
(g) Processor control number.
- (1) A processor control number is used by a processor to route an electronic claim within the processor to the appropriate area for adjudication.
- (2) The processor control number is a required data element if the processor requires it to adjudicate a prescription drug claim.
- (h) Group ID. If the processor requires a number to identify the cardholder’s employer, association, or other entity that has arranged the health benefit plan in order to process a prescription drug claim, the Group ID is a required data element.
- (i) Cardholder ID. A cardholder identification number is assigned by the health benefit plan.
- (j) Cardholder name. The cardholder name should be printed in the sequence given name and initials followed by the surname.
- (k) Claims submission name or names and address or addresses. This refers to the name and address of the health benefit plan and/or the name and address of the pharmacy benefits manager contracted by the health benefit plan to administer prescription drug claims.
(l) Help desk telephone number or numbers.
- (1) The telephone number of the entity that can respond to questions from a cardholder or pharmacist should be printed close to the claim submission name and address.
- (2) This telephone number should be clearly labeled (e.g., “Help Desk”, “Customer Service”, “Pharmacy Service”, etc.).