As patient access grows more complex, manufacturers need tools that reduce friction throughout the care journey. One valuable but frequently overlooked dataset is known as BIN/PCN/Group (BPG) data, which refers to a trio of identifiers used in pharmacy claims processing.
Unlocking the power of BPG data can transform claims bridging and streamline early benefit verification, helping pharma companies provide support to more patients in need.
What Is BPG Data, and Why Is It Elusive?
A patient’s drug benefit insurance card features their name, member ID, and plan group name—which is assigned by the payer, and does not necessarily correspond to PBM naming conventions. Three essential numbers are also encoded in the card’s magnetic strip:
- Rx BIN (prescription Bank Identification Number): This six-digit number identifies the specific insurance company or PBM processing the claim.
- Rx PCN (Processor Control Number): This alphanumeric code identifies the specific benefit package within a payer.
- Rx Group Number: This identifier points to the plan benefit structure within the payer, which indicates the correct coverage and pricing. Typically, this number identifies an employer, but it can also be a contract number for Medicare and Medicaid patients. Neither of these identifiers are easy to find or map, as CMS does not publish its contract ID numbers.
In order to route a pharmacy claim to the correct adjudication system, a pharmacy technician needs four pieces of information: the patient’s member ID plus their BPG numbers. Together, this data enables accurate claims processing, routing and coverage identification.
As there is no master database of all BPG numbers, many duplicates exist among adjudication systems and PBMs, which means that the same Rx Group number can be associated with several different BIN/PCN combinations. This complicates the plan matching process — especially for manufacturers, hubs, and support teams working directly with patients.
Read the full article in Drug Channels.
Learn more about MMIT’s Bridging as a Service, which maps various source IDs to our payer data backbone, providing clients with a single source of truth for ingestion or API delivery.
