Need to ask PAN for a reimbursement or submit a claim?
Learn the steps for sending a bill to PAN.
Providers and pharmacists should scroll to their specific billing guide. If you are a grant recipient or caregiver, please follow the steps below.
For grant recipients and caregivers
If your pharmacy or provider does not send the bill to PAN, you should:
- Pay the out-of-pocket cost for your medication or treatment
- Download the direct member reimbursement form below
- Send the form to PAN through the patient portal, mail, or by fax
After we have 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.
Direct reimbursement form
If you have a PAN grant, you can ask for reimbursement for approved expenses using the direct reimbursement form.
Don’t fill out this form if your provider or pharmacist has sent or will send a claim for you
For providers and pharmacies
Follow the steps below or download your specific billing guide for more information.
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:
| For Providers | Payer ID: 38225 Billing ID: 10-digit numeric ID unique to each patient |
| For pharmacies | Billing ID: 10-digit numeric ID unique to each patient Rx BIN: 610728 Rx Group: listed on page 9 of the 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 EOB/RA are legible. Illegible claims or incomplete claims will be returned and require resubmission, which can cause delays.
For providers:
| Include | 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 | Fax, mail, or upload claim(s) to: Online: Provider portal Fax: 1-844-726-4728 Mail: PAN Foundation PO Box 2310 Mt. Clemens, MI 48046 |
For pharmacies:
| Include | Completed Universal Claim Form or form CMS-1500 Corresponding RA or EOB statement |
| Submit | Fax, mail, or upload claim(s) to: Online: Pharmacy portal Fax: 1-844-871-9753 Mail: SS&C Health Dept. 0756 PO Box 419019 Kansas City, MO 64141 |
Claims forms
Do you need help submitting claims to PAN? Use the forms below to help you.
