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Medical Provider Claims: Frequently Asked Questions

 

 

 

The Patient Access Network (PAN) Foundation contracts with CoreSource, a third-party administrator, to process medical provider and direct member reimbursement claims. 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 approval letter.

» Group Number, which can be found on the patient’s PAN approval 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 Proof of Expenditure forms are for direct member reimbursement (DMR) 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 or PAN’s webinar on How to Process Medical Claims. 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 three ways to check claims and payment status:

 

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

» Access the CoreSource portal at mycoresource.com for detailed information on submitted claims. To get started, select the “Create My Account” button in the “I am a provider” box, and complete the requested information.

» 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 and whether information is missing. 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.

 

Need more information on claim denials? Check out our Medical Claims Portal webinar.

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 included, 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 or the CoreSource Portal?

If you have questions about the PAN Provider Portal or the CoreSource Portal, please refer to PAN’s webinar on Medical Claims Portal. You may also contact PAN at (866) 316-7263, Monday through Friday, from 9 a.m. to 5 p.m. ET.