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Medical Provider Claims: Frequently Asked Questions

 

 

 

Here are some of the commonly asked questions we receive from healthcare providers about the claims submission process.

1. What information do I need to submit a claim?

» Billing ID Number, which contains numerals only, and can be found on the patient’s PAN welcome letter.

» Group Number, which can be found on the patient’s PAN welcome letter.

» Claim form (HCFA-1500, UB-04 or UB-92). Click here for a list of required fields on the claim form.

 

Note: Providers must submit the actual claim form. Copies of electronic forms will not be accepted.

 

» Supporting documentation

»    Primary and secondary explanation of benefits, as applicable.

»    W-9 (required annually with your practice’s first claim of the year).

 

Note: PAN’s Direct Member Reimbursement (DMR) forms are for member reimbursement only.

2. How do I submit a claim to PAN?

You can submit claims electronically through your billing system, or by fax or mail using the contact information below:

 

» Electronic:         Payer ID 38225 (Payer ID is tied to NGS American)

» Fax:                     (844) 726-4728

» Mail:                   PAN Foundation

               PO Box 2310

               Mt. Clemens, MI 48046

3. What if I have questions about submitting a claim?

If you have questions about submitting a claim, please refer to the Provider Billing Guide. You may also contact PAN at 866-316-7263, Monday through Friday, from 9 a.m. to 5 p.m. ET.

4. How can I submit more than one claim?

Electronic claims must be submitted one at a time. To fax or mail more than one claim, please complete and include the PAN Medical Claim Fax Cover Sheet between every individual medical claim.

5. How long does it take for a claim to be processed?

The standard processing time for complete claims is 10 to 14 business days. Claims are processed on a first-come, first-served basis. Please keep in mind that any missing information may lead to delays in claim processing time.

6. What are the payment methods for claims?

There are three payment options for providers: QuicRemit virtual credit cards, ACH transfers or paper checks. QuicRemit virtual credit cards are the default payment method. All direct member reimbursement claims are paid by check only.

 

If you would like to continue receiving QuicRemit virtual credit cards, no further action is needed. If you would like to receive payment with paper checks or ACH transfers, please contact ECHO Health, PAN’s third-party healthcare payment vendor, at (440) 835-3511, extension 106, Monday through Friday, 8:30 a.m. to 6 p.m. ET, or This email address is being protected from spambots. You need JavaScript enabled to view it..

7. How do I check claims and payment status?

There are two ways to check claims and payment status:

 

» View payment details through the PAN Provider Portal at providerportal.panfoundation.org

» Call PAN at 866-316-7263, Monday through Friday, 9 a.m. to 5 p.m. ET.

8. How can I receive faster claim payment?

For faster payment, we recommend submitting claims electronically. Electronic claim submission ensures that claims are complete, and reduces the turnaround time by two business days.

 

Want to sign up for electronic claim submission? Contact your billing vendor for more information.

9. My claim was denied. What should I do?

If your claim was denied, it will be returned to you along with a letter indicating the reason for denial. You can also check the provider remittance for the claim denial reason. If additional information is required or you would like the claim to be reconsidered, please resubmit the claim with both the original documents and updated information.

10. When I resubmitted my claim with all the required information, it was denied and marked as a “duplicate claim.” What should I do?

If you are resubmitting a claim with all the required information, be sure to write “Corrected Claim” at the top of the claim form so the PAN team knows that new information has been added.

11. Where can I find a listing of covered diagnosis codes? 

Covered diagnosis codes can be found on each disease fund page on the PAN website, and here.

12. Where should refunds be mailed?

Please submit refunds to the following address:

PAN Foundation

PO Box 2310

Mt. Clemens, MI, 48046

13. What if I have questions about the PAN Provider Portal?

If you have questions about the PAN Provider Portal, please contact PAN at 866-316-7263, Monday through Friday, from 9 a.m. to 5 p.m. ET.

What Providers Say About Us

 

Do you have a PAN story? We would love to hear from you! Please click here to share your PAN story today.

PAN is literally a life saver. Keep up the great work! - Becky
PAN is the first place that we check because of the seamless and quick process. -Chiara
I’ve been able to assist many patients who, without PAN, would not be able to sleep at night wondering how they could pay. So on behalf of patients, I thank you! - Marjorie
Simply put, PAN makes my job easier. -Nadira
I like calling PAN. The representatives are friendly and helpful. They tell me if the patient is approved instantly. -Lauren
PAN’s income guidelines help give hope to people who fall through the cracks of other assistance sources. -Patrice
Your program is fantastic and has helped so many. Thank you on behalf of all the patients I refer! - Nicole
PAN is the most reliable patient assistance organization. It’s the first place I go when I’m trying to help my patients. -Susan
The generosity of foundations like PAN is unparalleled. PAN’s assistance really makes a difference. -George

Provider Resources

 
Provider Brochure

This PAN provider brochure provides essential information to help our providers assist their patients quickly and efficiently.

What Providers Say About Us

We continue to collect stories from PAN providers about their experiences working with us.

Provider Quarterly Newsletter

At PAN, we always strive to offer our providers new and relevant information. That's why we produce a provider-specific quartlerly newsletter.

Who Qualifies for PAN?

 

Patients must meet the following criteria to be eligible for PAN assistance:

  1. The patient must be getting treatment for the disease named in the assistance program to which he or she is applying.
  2. The patient must have health insurance that covers his or her qualifying medication or product.
  3. The patient’s medication or product must be listed on PAN’s list of covered medications.
  4. The patient’s income must fall at or below 400% or 500% of the Federal Poverty Level, depending on fund-specific guidelines.
  5. The patient must reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)

Click here to see if your patient qualifies for PAN’s Medicare-only funds.

Apply Online

Apply Now

Or call 1-866-316-7263

PAN Webinar Library

 

 

 

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Introducing the Improved PAN Provider and Pharmacy Portals 2017

This webinar focuses on updates to the PAN Provider and Pharmacy Portals and gives a preview of the new features.

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PAN Webinar #1: Introduction

In this Introduction to PAN Webinar, you will learn how to navigate the PAN website, find disease funds and covered medications, what materials and information are needed to use the web portals and more.

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PAN Webinar #2: PAN Provider and Pharmacy Portals - How to Enroll a Patient

In this Patient Enrollment Webinar, you will learn how to access and use the Provider and Pharmacy Portals to enroll a patient.

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PAN Webinar #3: Portal Management

In this Portal Management Webinar, you will learn how to access and navigate the recently enhanced Provider and Pharmacy Portals.

 

 

The PAN Challenge

The Patient Assistance Safety Net:
How Many Need Help? How Many Are Helped?

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2017 PAN CHALLENGE
PAN and AJMC® Announce the

2017 Call for Papers

 

The Patient Access Network (PAN) Foundation and The American Journal of Managed Care® (AJMC®) seek papers that quantify the need for patient assistance and the size of the safety net, and answer the following questions.

 

Need for Patient Assistance

 

For the underinsured population, how many people need financial assistance to pay for the out-of-pocket (OOP) costs associated with their prescription medications? What is the dollar amount of assistance that is needed?

 

Safety Net

 

How large is the current safety net for people who need financial assistance to pay for the OOP costs associated with their prescription medications? How many and what kinds of safety net programs are available? What diseases and medications do they cover? How much assistance do they provide? How many people are unable to get the help they need? Are there factors that limit the reach of safety net programs?

 

PAN Challenge entrants shall:

 
  • » Address either the need for patient assistance or size of the safety net, or both.

  • » Describe the research conducted to analyze and quantify the need for patient assistance and/or the size and characteristics of the safety net.

  • » Identify the population and specific medical conditions researched, if appropriate.

  • » Identify proposed recommendations to address the need for patient assistance and gaps in the safety net.

 

Eligibility

 

The PAN Challenge is open to individuals and teams of individuals who are sponsored by: a) a university or college; b) a department/school within a university/college; c) a health system; d) a nonprofit organization; or e) a for-profit entity. Collaborations are encouraged between organizations; however, one will be designated as the Sponsoring Organization.

 

How to Enter

 

Entrants are required to read the Official Rules for the PAN Challenge. Those interested in submitting an abstract should provide the necessary information included in the Rules by October 31, 2017. All information is submitted to Amy Niles, Vice President, External Affairs, PAN Foundation at This email address is being protected from spambots. You need JavaScript enabled to view it..

 

Prizes

 
  • » One Sponsor Organization will be selected as the Winner of the PAN Challenge and will receive $10,000.

  • » One Sponsor Organization will be selected as the Runner-Up of the PAN Challenge and will receive $5,000.

  • » Up to three Sponsor Organizations will be selected as Honorable Mentions of the PAN Challenge and will each receive $1,500.

  • » The Winner and Runner-Up will each be given an opportunity to present at the Cost-Sharing Roundtable, to be hosted by the PAN Foundation and AJMC®, tentatively scheduled for February 2018.

  • » Papers of the Winner and Runner-Up Sponsor Organizations will be published in a future print and online supplemental edition of AJMC®. Sponsor Organizations of Honorable Mentions may receive recognition and be included in the Supplement.

For more information about the 2017 Call for Papers:

 

 

 

For more information about the PAN Challenge, contact PAN Foundation's Vice President of External Affairs Amy Niles at This email address is being protected from spambots. You need JavaScript enabled to view it. or 202-661-8073.
 

 

 

 

 

What Healthcare Providers Say About PAN

 

MJ Kelly, Director of Billing and Reimbursement, CVS/Caremark Specialty Pharmacy

“Our goal is to get patients on therapy as quickly as possible. PAN’s portal allows us to do just that. Patients are approved quickly and move forward with their therapy rather than going without medication or making other major financial sacrifices. Not only does PAN provide a wide range of therapies and generous amount of funding per patient, they also have a passion for what they do. It’s quite moving to see what PAN is able to provide for our patients.”

 

Angela Magaha, Patient Advocate Manager, Park Pharmacy and Tennessee Oncology

“PAN offers the portal access, which gives us the opportunity to work with the patient, and it allows patients to stay ahead in getting their co-payment assistance. It also allows our team to process information efficiently - we’re able to help more patients because we’re able to process a patient on the portal within 15 minutes of just entering the information.”

 

Stacey McCullough, PharmD, Director of Pharmacy Services, Park Pharmacy and Tennessee Oncology

“Working with the PAN Foundation, an organization that has streamlined the process and made getting the required information as easy and as quick as possible, is very beneficial. It helps us out from a business standpoint to be able to provide this service, in all aspects of care. To have a partner that recognizes the end goal is very valuable.”

 

Anne Hollingsworth, Funding Supervisor, Diplomat Pharmacy

“A differentiator for PAN is its efficiency. The turnaround time is great. When patients can access grants quickly, it makes it easy for us and takes a lot of the stress off patients. Everyone wins.”

 

Brad Zimmerman, MSW, APSW, OSW, Oncology Social Worker, Aurora Advanced Healthcare in Milwaukee

“I am proud of the fact that with the help of organizations like PAN, our practice is able to identify assistance for about nine out of 10 of our patients who are struggling to pay for treatment. We work hard to make sure our patients have the opportunity to get the first line of therapy that they are prescribed. Patients are so appreciative and thankful when life-saving treatments are accessible because of PAN’s assistance.”

 

John Helfrich, Director of Pharmacy Operations, Oncology Rx Care Advantage Pharmacy

“Among underinsured patients, people understand a treatment might mean dipping into savings or everyday expenses to pay out-of-pocket costs. Once they weigh expensive options, patients often choose a less costly route. That is where PAN comes in. PAN allows doctors to offer the best treatment, focusing on treating the patient in the way that is most suitable. The PAN portal offers us the opportunity to input and process information faster, saving numerous days of worry for patients. PAN offers providers value-added information, too. Through our connection with PAN, we receive email updates about new funding. Our mission is to serve the patients and walk beside them through their illnesses. PAN helps us do that...it's a leap forward in assistance with patients.”

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Benefits of Working with PAN

 

In a recent survey, more than 80 percent of PAN providers said healthcare costs were impacting their medication and treatment decisions more now than one year ago.

Patients should never have to face major financial trade-offs, like selling their homes, in order to follow their treatment plans. That’s why providers play a vital role in linking PAN and underinsured patients who need help to afford the co-payments, coinsurance and deductibles associated with their medications.

More than 95 percent of PAN providers say PAN support has a positive impact on patients’ ability to comply with treatment. The caring and highly trained staff at PAN carefully guide providers and advocates through the application and claims process. Several key benefits in working with PAN include:

  • » Ease of billing
  • » Quick payment (fewer than 10 business days)
  • » Quick access to patient information through online patient and provider portals
  • » Patient eligibility for PAN support determined instantly