A glossary for Canadian pharmacy billing conversations

Plain-language definitions for the claim, plan, code, and documentation terms used throughout FRx.

Pharmacy billing language compresses many ideas into short labels. A patient may hear “plan,” “carrier,” “group,” “DIN,” “PIN,” “override,” and “authorization” during one counter conversation. A shared glossary reduces mistakes because it forces each term to do only one job.

Adjudicator

The system or pharmacy benefit manager that receives the claim, applies electronic edits, and returns a response. An adjudicator may process claims for many insurers, sponsors, or public programs.

Carrier

The routing identity used by pharmacy software to send the claim to the correct benefit environment. The carrier may be an insurer, a public program, or an adjudicator-specific code representing a plan.

Group

A plan sponsor or benefit class identifier. The same insurer may have many groups. Group validity does not guarantee that a specific drug is covered.

Certificate or member number

The covered person or family identifier. Some plans require a suffix, issue number, or relationship code to distinguish dependants.

DIN, PIN, and pseudo-DIN

A DIN identifies a drug product authorized through Health Canada. A PIN or pseudo-DIN may be used by a public plan, carrier, or program to identify a service, supply, compound, or non-DIN item for adjudication purposes.

Intervention code

A code submitted by the pharmacy to describe a professional action or claim circumstance. It should match the record and the payer’s accepted code list.

Prior authorization or special authorization

A review pathway required before coverage is granted. The form owner, criteria, and approval target can differ by public program, private sponsor, dose, drug, or patient category.

Coordination of benefits

The ordered submission of a claim through more than one payer. Correct coordination depends on first-payer rules, residual amounts, and plan-specific restrictions.

Manual submission

A pathway outside the ordinary online pharmacy transaction. Receipts, forms, or program review may be required before payment is determined.

Why definitions reduce claim errors

Many claim errors begin as language errors. A staff member may ask the patient for a “policy number” when the software needs a certificate number. A patient may provide a medical plan number when the pharmacy needs the drug group. A prescriber may hear “prior authorization” when the plan actually requires a public exception pathway. Using precise terms keeps the next action clear.

The glossary should be read with the tool open. When a carrier entry uses a term such as group, client ID, issue number, pseudo-DIN, or intervention code, the definition should make the field easier to interpret. If a term is still ambiguous after reading the glossary, the current card or payer manual should control.

FRx guide page · Static editorial reference · Last reviewed 2026-05-02