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Submitting claims

Understand the claims process, how to submit claims, and how to submit patient reimbursements

Need to ask PAN for a reimbursement or submit a claim? Learn the steps for sending a bill to PAN.

Review your specific claims and billing information, including detailed instructions on how to file claims:

Claims process overview

For patients or caregivers

If your pharmacy or provider does not send the bill to PAN, follow these steps:

  1. Pay the out-of-pocket cost for your medication or treatment
  2. Download the direct member reimbursement form
  3. Send the form to PAN through the patient portal, mail, or by fax

After we get your completed form, you should get a check within 10 business days. You can always call us to check the status of your reimbursement request.

Get complete details about the reimbursement process for patients and their caregivers:

For providers and pharmacies

The PAN Foundation contracts with Trustmark Health Benefits to process medical claims, and with SS&C Health, to process pharmacy claims. PAN is the payer of last resort, so all patients must be insured, the patient’s insurance must cover their medication, and the patient’s medication or product must be listed as a covered medication.

Get complete details about the claims process, what’s covered, how to submit a claim, and more on our pages specific to providers and pharmacies:

Submit an electronic claim

Electronic claims may be submitted directly via your billing software and are the preferred and fastest way to submit a claim. Electronic claims are processed within five business days for providers, or in real-time for pharmacies.

Please include the following information:

PROVIDERS:
Payer ID:38225
Billing ID:10-digit numeric ID unique to each patient
PHARMACIES:
Billing ID:10-digit numeric ID unique to each patient
Rx BIN:610728
Rx Group:Listed on page 9 of the pharmacy billing guide
Rx PCN:PANF

Submit a manual claim

Manual claims must be submitted and are processed on a first-come, first-served basis. We recommend waiting five business days before following up on claims.

Make sure the claim form is complete and the explanation of benefits (EOB) or medical remittance advice (RA) are legible. Illegible claims or incomplete claims will be returned and require resubmission, which can cause delays.

Providers

Please include the following information:

  • W-9 form (required annually for each practice)
  • Completed CMS-1500, UB-92 or UB-04 form
  • Corresponding itemized Explanation of Benefits (EOB) or Medicare Remittance Advice (RA), showing insurance payment

Submit via one of these methods:

  • Upload claims online: Provider portal
  • Fax to: 1-844-726-4728
  • Mail to: PAN Foundation, PO Box 2310, Mt. Clemens, MI 48046

Pharmacies

Please include the following information:

  • Completed Universal Claim Form or form CMS-1500
  • Corresponding RA or EOB statement

Submit via one of these methods:

  • Upload claims online: Pharmacy portal
  • Fax to: 1-844-871-9753
  • Mail to: SS&C Health, Dept. 0756, PO Box 419019, Kansas City, MO 64141

Billing guides

Need updated PDFs of our billing guides? Download them here. You can also visit our pages with detailed claims information for patients, providers, and pharmacies.

Forms

Claims and billing help

If you need help with claims, billing, or reimbursement, you can message us through your PAN portal, or call us at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET.