How to file a claim

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 ProvidersPayer ID: 38225
Billing ID: 10-digit numeric ID unique to each patient
For pharmaciesBilling ID: 10-digit numeric
ID unique to each patient
Rx Group: listed on page 9 of the billing guide

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:

IncludeW-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.
SubmitFax, 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:

IncludeCompleted Universal Claim Form or form CMS-1500
Corresponding RA or EOB statement
SubmitFax, 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.