BIN-PCN for Routing Supplemental Transactions

The Supplemental Payer Routing BIN/PCN table is used by switches to determine which transactions are routed to the TrOOP Facilitator and to identify, transmit and process B transactions through the coordination of benefits (COB) process. The TrOOP Facilitator uses these transactions to attempt to generate N transactions, which are used by Part D plans to adjust beneficiaries’ TrOOP balances. Prior to January 1, 2012, the Coordination of Benefits Contractor (COBC) created the BIN/PCN table and provided it to The Transaction Facilitator, for distribution to the switches.

In order to better meet CMS coordination of benefits requirements, CMS transferred the ownership and management of the list of BIN-PCNs to The Transaction Facilitator effective 1-1-2012. Under the direction of CMS personnel, The Transaction Facilitator’s control and maintenance of the list of BIN-PCNs is anticipated to result in a higher rate of compliance and quicker response time for updates to new or revised BIN-PCNs related to supplemental payers. By utilizing specific criteria The Transaction Facilitator will be able to determine, through CMS eligibility records, which BIN-PCNs are supplemental to Part D, allowing the switches to B transactions that may potentially result in Ns.

The Transaction Facilitator maintains a list that represents payers that are supplemental to Part D. This list is derived based on the following criteria:

  1. CMS file of BIN/PCNs reported by SPAP/ADAPs
  2. BIN/PCNs for Plans supplemental to Part D reported by either the plan or a processor
  3. BIN/PCNs contained in Other Health Insurance (OHI) records on the CMS Eligibility File where:
    1. A BIN/PCN combination where the PCN is not blank has more than 10 beneficiaries;
    2. BIN is registered with the switches for real-time processing;
    3. BIN/PCN for supplemental payer does not match a Part D BIN/PCN (DOS 1-1-2012 and later);
    4. BIN-PCN is a valid BIN-PCN as identified a processor;
    5. PCN does not contain all the same digits;
    6. BIN and PCN do not contain the same values;
    7. PCN is “NA”, “N/A”, or “NONE”;
    8. BIN/PCNs that have not been requested to be removed by the owner or processor ; and/or
    9. A BIN/PCN combination where the PCN is blank and
      1. The BIN is on the SPAP/ADAP table with a blank PCN and the BIN is unique to the SPAP/ADAP, or
      2. the processor specifies in writing that a commercial BIN and blank PCN is solely for plans Supplemental to Part D, or
      3. the blank PCN has more than 50 records.

The Transaction Facilitator and CMS reserve the right to remove any BIN/PCN for which low N transaction/eligibility match rates cannot be resolved.