Frequently asked questions for pharmacists
We contract with SS&C Health to process pharmacy claims. Here are some of the commonly asked questions we receive from pharmacists about enrollment, filing a claim, our grant use policy and more.
PAN is the payer of last resort, so all patients must be insured, and their insurance must cover the medication or supply for which the patient seeks assistance.
PAN provides reimbursement in the form of grants for deductible, co-payment and coinsurance amounts for medications or supplies on our formulary. Review our full list of covered medications and supplies.
A few assistance programs cover insurance premiums, as well as ancillary travel expenses incurred while traveling to receive medical treatments.
The following items are not reimbursable by PAN:
- Eligible medications or over-the-counter products not covered by the patient’s insurance.
- Eligible medications paid by the insurance payer at 100%.
- Eligible medications billed only to drug discount cards and not insurance.
- Medical services, such as lab work, preventative vaccinations, diagnostic testing, genetic testing, ER visits and office visits.
- Medications not covered under PAN’s formulary for the corresponding disease fund.
Patients must meet the following criteria to be eligible for PAN assistance:
- The patient must be getting treatment for the disease named in the assistance program to which he or she is applying.
- The patient must have health insurance that covers his or her qualifying medication or product.
- The patient’s medication or product must be listed on PAN’s list of covered medications.
- The patient’s income must fall at or below the Federal Poverty Level specified by the assistance program. Visit our programs to learn more about each fund’s income requirements.
- The patient must reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)
You will need the following information to apply:
- Patient’s demographic information (name, address, phone number).
- Diagnosis and medication name(s).
- Patient’s health insurance information.
- Patient’s income and number of people in the household.
- Physician and facility’s contact information.
Each grant eligibility period is 12 months. However, first-time grant enrollees to a disease fund have a 90-day look back period to cover qualified claims incurred prior to enrollment.
A renewal grant can be awarded after the grant period has ended, starting a new eligibility period for use. You may apply to renew a grant up to thirty days before the current grant period ends, even if there is still a grant balance remaining. Patients may start using renewal grants, if awarded, in the next grant period.
Please note: This is different than a second grant, which can only be awarded if the full value of the original grant is used and there is time remaining in a patient’s eligibility period. See question 30 for more information.
Grants may be renewed starting 30 days before the eligibility period ends.
No, you do not need to join the SS&C network before submitting claims to PAN. However, if the Centers for Medicare & Medicaid Services (CMS) or other government regulatory agencies have sanctioned a pharmacy, PAN reserves the right to exclude that pharmacy from submitting claims.
Joining the SS&C network allows you to process other health insurance, Medicare Part D, discount card, and co-pay assistance claims through SS&C’s clearinghouse—contingent on if the insurance plan or co-pay assistance program uses SS&C as their claims processor. SS&C also sends informative bulletins and industry updates to network pharmacies.
Electronic Claim Submissions
Electronic claims are processed immediately. To submit an electronic claim, please use the following billing information:
- Billing ID*: 10-digit numeric ID unique to each patient
- Rx BIN: 610728
- Rx Group: Refer to “Pharmacy Billing Guide”
- Rx PCN: PANF
You can submit claims electronically through your billing system. If you cannot bill PAN electronically, you may submit manually by fax or mail.
Manual Claim Submissions
- Please submit the following items:
- Fax or mail claim(s) to:
- Fax: 1-844-871-9753
- Mail: SS&C Health
PO Box 419019
Kansas City, MO 64141
Please refer to our Pharmacy Billing Guide for more information on how to submit a claim.
Electronic claims are processed immediately. The standard processing time for manual claims is 10 to 14 business days. Claims are processed on a first-come, first-served basis. Please keep in mind that any missing or illegible information may lead to delays in claim processing time.
When faxing or mailing multiple claims, each claim must have its own claim form and EOB/RA statement. Please separate claims with a blank page or fax cover sheet to ensure each claim is processed correctly.
There are two ways to check claims and payment status:
If your claim was denied, we will provide you with a rejection code and denial reason. If additional information is required or you would like the claim to be reconsidered, please resubmit the claim with the requested information (see Pharmacy Billing Guide to learn more).
In addition, we have an appeal process that may be used in extenuating circumstances. We encourage you to contact us at 866-316-7263 if you would like to learn more.
At the end of the patient’s grant period, you have 60 days to submit any outstanding claims with dates of services that are within the eligibility period.
SS&C Health payments are issued via electronic funds transfer (EFT) and paper checks. SS&C Health payment cycles are twice a month and are issued on the 16th and the last day of each month. For additional information, contact the SS&C Health reconciliation team at 866-211-9459 or email@example.com.
SS&C Health provides electronic remittance advice once the claim has been processed. The remittance advice is accessible at www.argushealth.com/login. Please see the Pharmacy Billing Guide for instructions on how you can access the payment portal if you do not have an account. SS&C Health does not issue paper remittance advice.
SS&C Health does not accept refund checks.
- For Single Claim Adjustments: contact the SS&C Health Help Desk at 844-616 9448.
- For Multiple Claim Adjustments (5 or more claims): please visit https://www.argushealth.com/myargus/MyArgus and complete the Multiple Adjustments Request Form. Please see the Claims Adjustments section of the Pharmacy Billing Guide for more information.
Any adjustment transactions will be reflected in the next pay cycle.
Grant Use Policy
PAN’s Grant Use Policy encourages grant recipients to use their grants as intended to help cover the out-of-pocket costs for critical medications. The patient, healthcare provider or pharmacist must request and receive payment for a claim from PAN within 120 days of the enrollment date. Throughout the patient’s eligibility period, you must submit one paid claim during each 120-day period.
If grant recipients do not follow the Grant Use Policy, their grants will be canceled, and the released funds will be used to provide grants to other patients who need assistance. If the patient needs assistance at a later date, you are welcome to reapply for assistance on their behalf, pending fund availability. If you have questions or extenuating circumstances, please call us at 866-316-7263.
There is no set number of claims that must be submitted per year. However, you must request and receive payment for a claim from PAN during each 120-day period. Please see question 23 to learn more.
PAN grant recipients must be currently in treatment, scheduled to begin treatment in the next 120 days or have had treatment in the past 90 days. We recognize that your patient’s treatment may not fit within the 120-day timeframes of the Grant Use Policy. If their treatment is only once or twice a year, and you or your patient receives a letter from PAN indicating that their grant must be used soon, please call us at 866-316-7263. We will take this under consideration.
Yes, there must be a paid claim on file in order for the 120 days to start again, or you must have been approved for an extension from PAN.
A second grant can be awarded if the patient’s grant balance is depleted before their eligibility period ends. If approved, the patient will be able to use funding from the second grant during the remainder of their eligibility period.
Please note: This is different than a renewal grant, which can be awarded for use in a new eligibility period. See question six for more information.
If your patient’s grant is exhausted during their eligibility period, you may apply for additional assistance called Second Grants. To qualify, the current grant balance must be $0, and the disease fund must be open. Simply go to the pharmacy portal or call us at 866-316-7261 to see if your patient qualifies.
If a previous claim was partially paid, you may reverse and reprocess the claim for the full patient responsibility after the second grant is awarded.
Disease Fund Wait List
The Disease Fund Wait List is a list of patients waiting to apply for assistance from a closed co-pay, travel or premium disease fund at the PAN Foundation.
Patients may add themselves to the wait list or be added by their healthcare provider, pharmacy or caregiver. All patients or the individual acting on their behalf must provide a valid email address in order to sign up for the wait list.
The wait list enhances our ability to serve patients on a first-come, first-served basis by giving those on the wait list the first opportunities to apply for assistance when a fund opens.
When funding becomes available for a specific disease fund, individuals on the Disease Fund Wait List will be notified by email that the fund is open for applications—this is the period that a fund is considered to be in wait list status. The individuals on the wait list have the opportunity to apply before the general public during the wait list status.
Each disease fund that is closed has a wait list. Patients may add themselves to the wait list or be added by their healthcare provider, pharmacy or caregiver. There is no limit to the number of people who can be on the wait list at any given time.
Each patient on the wait list will be assigned a number corresponding to the order in which they were added to the list. Your patient’s number on the wait list will not be publicly available through the portals or by calling us by phone.
The entire process from the time the fund opens for application to notification of a successful grant takes four business days. Here’s a look at the overall timeline:
Business day 1:
- When we have secured funding for a closed disease fund, we will open that disease fund in wait-list status, and those on the wait list will get an email inviting them to apply for assistance with a unique URL and Wait list ID. Applications can be submitted via the portal or by calling PAN.
- The application period is open for two business days. At the end of the two-business day period, we will no longer accept applications from the wait list.
Business day 2:
- At the end of the two-business day period, we will no longer accept applications from the wait list.
Business day 3:
- The application period is now closed.
Business day 4:
- Within four business days, the patient, caregiver, provider or pharmacist will be notified by email whether a grant will be awarded.
- If your patient is awarded a grant, they can begin to use their grant immediately.
- If your patient is not awarded a grant due to insufficient funds, they will stay on the wait list, but move closer to the top. They will not lose their place on the wait list. They will be notified the next time the disease fund opens in wait-list status and will need to submit an application again.
Please note that the email address used when signing up for the wait list will also be used to provide updates on the fund’s status. We encourage you to ensure that the email address is checked often.
For the quickest way to add your patients to the wait list, utilize our portals. Reference our step-by-step instructions on how to sign your patient up for the wait list on the pharmacy portal.
If your patients need assistance from a closed disease fund, we encourage you to sign them up for the wait list. You must sign each patient up for the wait list individually.
When a PAN disease fund is closed, the PAN website will always have up-to-date referrals if there is an open program at another foundation. We also encourage you to sign up and follow funds on FundFinder for instant alerts when a disease fund opens at any of the charitable patient assistance foundations.
If your patient no longer needs help, contact us by phone at 1-866-316-7263 to remove their name from the wait list or send us a secure message on your portal.
If you applied on behalf of your patient, you will receive an email confirmation that they have been added to the wait list.
You can also log in to the pharmacy portal to confirm your patient’s placement on the wait list. Simply select “Disease Fund Wait List,” and scroll to the specific disease fund to select “See list.” The portal will display all associated patients that have been enrolled on a wait list by their pharmacy.
When a closed disease fund moves into wait-list status, patients on the wait list will receive an email inviting them to apply. You will receive the invite to apply if you provided your email address on behalf of your patient when adding them to the wait list. Once the email goes out, people on the list will have two business days to apply for assistance.
The email will include a unique URL and wait list ID which will be required to apply for assistance from the wait list.
There are two ways to submit an application on behalf of your patient:
- Pharmacy portal:
When you click the unique URL in the invitation email, you will be directed to the pharmacy portal and can continue the application process as normal on behalf of your patient. The portal is available 24/7.
- Phone: 1-866-316-7263
Your email also includes a wait list ID for your patient. When you call us to apply, please have that wait list ID at the ready for the representative and they will be able to assist you through the application process.
Once we receive all applications at the end of the two business days, you will be notified by email within another two business days whether a grant can be awarded.
- Pharmacy portal:
You are welcome to add your patient to a wait list even if a program is open at another foundation. However, we recommend that you contact the open program to ensure your patients can find assistance as quickly as possible.
PAN’s Disease Fund Wait List is a list of patients waiting to apply for assistance from a closed fund at PAN. When a closed PAN fund goes into wait list status, patients on the wait list will receive an email inviting them to submit an application to PAN.
FundFinder is a tool that tracks the availability of funding across 9 different charitable organizations, including PAN. With FundFinder, you can sign up for email or text message notifications to learn when financial assistance becomes available for a specific diagnosis at any foundation.
We encourage you to sign up and follow funds on FundFinder for instant alerts when a disease fund opens at any of the charitable patient assistance foundations.