23 CAR Part 116 — Rule to Implement Acts 2001, No. 1409 — Uniform Prescription Drug Information Cards

Chapter I

Subchapter B

Subpart 1

23 CAR § 116-101 Purpose {#sec-23-car-116-101 omnilex-key=us-ar-regs-official--title-23-part-116--23 CAR § 116-101}

23 CAR § 116-101. Purpose.

The purpose of this part is to provide that certain data elements appear on prescription drug information cards so that pharmacists have a consistent means of finding the necessary information to correctly submit prescription claims.

23 CAR § 116-102 Applicability and scope {#sec-23-car-116-102 omnilex-key=us-ar-regs-official--title-23-part-116--23 CAR § 116-102}

23 CAR § 116-102. Applicability and scope.

This part is applicable to any entity issuing a health benefit plan unless such health benefit plan is exempted by Arkansas Code § 23-80-403.

23 CAR § 116-103 Compliance date {#sec-23-car-116-103 omnilex-key=us-ar-regs-official--title-23-part-116--23 CAR § 116-103}

23 CAR § 116-103. Compliance date.

All prescription drug information cards issued, delivered, modified, or extended by health benefit plans shall comply with the terms of this part no later than April 9, 2003.

23 CAR § 116-104 Definitions {#sec-23-car-116-104 omnilex-key=us-ar-regs-official--title-23-part-116--23 CAR § 116-104}

23 CAR § 116-104. Definitions.

As used in this part:

(1) “Card issuer” means the insurance company, hospital medical service corporation, health maintenance organization, or other entity issuing a health benefit plan that provides prescription drug benefits;

(2) “Dual-use health benefit plan/prescription drug information card” means a prescription drug information card that contains information for the processing of claims for healthcare services, supplies, or equipment in addition to prescription drugs or devices;

(3) “Health benefit plan” means any individual, blanket, or group plan, policy, certificate, or contract for healthcare services issued or delivered in Arkansas, including indemnity plans, managed care plans, plans provided or arranged by fraternal benefit societies, plans provided or arranged by health maintenance organizations, health governmental plans as defined in 29 U.S.C. § 1002(32), as in effect January 1, 2001, plans provided through a multiple employer welfare arrangement, or plans provided through another benefit arrangement, to the extent permitted by the Employee Retirement Income Security Act of 1974, as in effect January 1, 2001, or by any waiver of or other exception to that act provided under federal law or regulation, as in effect January 1, 2001;

(4) “Prescription drug information card” means an identification card-sized document that contains information necessary for a pharmacist to communicate claims information to a processor to adjudicate claims for prescription drugs and devices;

(5)(A) “Processor” means the entity that electronically receives and adjudicates a prescription drug claim.

(B) The processor may be a pharmacy benefits manager or the card issuer; and

(6) “Stand-alone prescription drug information card” means a prescription drug information card that provides information solely for the processing of claims for prescription drugs and devices.

History

• Codification Notes: The Employee Retirement Income Security Act of 1974 is codified generally as 29 U.S.C. § 1001 et seq. Authorities: Arkansas Code § 23-61-108; Arkansas Code § 23-80-409

23 CAR § 116-105 Stand-alone prescription drug information card {#sec-23-car-116-105 omnilex-key=us-ar-regs-official--title-23-part-116--23 CAR § 116-105}

23 CAR § 116-105. Stand-alone prescription drug information card.

(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:

(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.).

23 CAR § 116-106 Dual-use health benefit plan/prescription drug information card {#sec-23-car-116-106 omnilex-key=us-ar-regs-official--title-23-part-116--23 CAR § 116-106}

23 CAR § 116-106. Dual-use health benefit plan/prescription drug information card.

(a) A health benefit plan that provides coverage for health services in addition to prescription drugs or devices may, at its option, include prescription drug claims information necessary to process prescription drug claims on the health benefit plan identification card or other technology.

(b)(1) This dual-use health benefit plan/prescription drug information card (“dual-use card”) shall include the data elements described in 23 CAR § 116-105(d) that are necessary to process a claim for prescription drug benefits under the health benefit plan.

(2) However, the health benefit plan may determine the location of these data elements on such dual-use card.