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054.00.75-6. Stand-Alone Prescription Drug Information Card

AR ADC 054.00.75-6Arkansas Administrative Code

West's Arkansas Administrative Code
Title 054. Insurance Department
Division 00.
Rule 75. Uniform Prescription Drug Information Cards Regulation
Ark. Admin. Code 054.00.75-6
054.00.75-6. Stand-Alone Prescription Drug Information Card
Currentness
14. A prescription drug information card shall include in a clear, readable and understandable manner all information data elements set out in § 6.b. of this Rule that are necessary to process a claim for prescription drug benefits under the Health Benefit Plan.
15. Font Size. The font size for the data elements required by this rule and regulation shall be 8 points or greater.
2. Dates. 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). 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.
16. 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
17. Card Issuer Name or Logo. The card issuer name may be the legal name or the trade name of the issuing Health Benefit Plan.
18. RX Bank Identification Number. The prescription bank identification number (“BIN”) is utilized in the electronic routing of pharmacy claims. The American National Standards Institute, 11 West 42nd Street, New York, NY 10036, (212) 642-4900, assigns a BIN to each processor.
19. Processor Control Number. A Processor Control Number is used by a Processor to route an electronic claim within the Processor to the appropriate area for adjudication. The Processor Control Number is a required data element if the Processor requires it to adjudicate a prescription drug claim.
20. 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.
21. Cardholder ID. Cardholder identification number is assigned by the Health Benefit Plan.
22. Cardholder Name. The cardholder name should be printed in the sequence given name and initials followed by the surname.
23. Claims Submission Name(s) and Address(es). 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.
24. Help Desk Telephone Number(s): 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. This telephone number should be clearly labeled (e.g. “Help Desk,” “Customer Service,” “Pharmacy Service,” etc.).
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.75-6, AR ADC 054.00.75-6
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