Provider claims and billing

Information for healthcare providers about the grant claims and billing process

About provider claims

The PAN Foundation contracts with Luminare Health to process medical claims. You can submit claims for patients with active grants that cover deductibles, copayments, and coinsurance costs related to eligible medications or supplies.

PAN is the payer of last resort, so all patients must be insured, the patient’s insurance must cover their medication, and the patient’s medication or product must be listed as a covered medication for their disease fund.

What services are covered

PAN covers products that are FDA-approved or listed in official compendia or evidence-based guidelines for the specific disease fund. PAN reimburses:

All prescription medications in the disease fund formulary, including:

  • Brand medications
  • Generic medications
  • Bioequivalent or biosimilar drugs
  • Specialty drugs
  • Radiopharmaceuticals

Certain disease funds cover medical supplies for administering treatments, preventative vaccines, and health insurance premium assistance.

For medical claims, the diagnosis code submitted must be covered under the respective disease fund. To verify diagnosis code coverage and review the list of disease funds and covered medications, go to the Find a Disease Fund page and select the relevant disease.

PAN will not reimburse:

  • Medications or over-the-counter products not covered by the patient’s insurance
  • Medications paid by the insurance payer at 100%
  • Medications billed only to drug discount cards and not insurance
  • Medical services, such as lab work, diagnostic testing, genetic testing, ER visits, and office visits
  • Medications not covered under PAN’s formulary for the relevant disease fund

To request new medication coverage for a medication not covered by the patient’s grant, you can submit an online request or call us. Note that we cannot guarantee new medication coverage.

When to submit claims

If the grant is active, you may submit claims throughout the eligibility period. Grant eligibility periods are 12 months with a look back period of 90 days for any initial grant. At the end of the grant eligibility period, you have 60 days to submit any outstanding claims with dates of services within the eligibility period.

PAN’s grant use policy requires patients, or their representative, to request and receive payment for a claim from PAN every 120 days to keep the grant active. If a claim is not submitted and paid during that timeframe, the grant will be canceled.

Before submitting a claim

Check your patient’s grant balance

Before submitting claims, verify the patient’s grant balance using your PAN portal account. You can also use our 24/7 self-service option by calling 1-866-316-7263 and pressing 1 when prompted. You’ll need to provide the patient’s PAN member ID and date of birth.

Check if the patient is linked to your account

The patient must be linked to your PAN portal account before you can review claim submission status or review payment details.

How to submit claims

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. Please include the following information:

Payer ID:Billing ID:
3822510-digit numeric ID unique to each patient
(Payer ID is tied to Luminare Health)

Submit a manual claim

1. Collect your:

  • W-9 form (required annually for each practice and the first time they submit a claim to PAN)
  • Completed CMS-1500, UB-92, or UB-04 form.
  • Corresponding itemized Explanation of Benefits (EOB) or Medicare Remittance Advice (RA) showing payment by the insurance.

2. Make sure the claim form and the EOB/RA are legible. Illegible claims will be returned and require resubmission, which can cause delays.

  • For Diagnosis-Related Group (DRG) claims, the billing code/type on the claim form and the itemized or non-itemized EOB must indicate DRG.
  • For APC claims, make sure the EOB is itemized. If an itemized EOB is not available, contact PAN after submitting the claim.

3. Fax or mail claim(s) to:

  • Fax: 1-844-726-4728
  • Mail: PAN Foundation, PO Box 25946, Overland Park, KS 66225

Submitting multiple claims by fax or mail

Each date of service needs its own claim form and EOB/RA. Separate each date of service submission with a blank page, or a fax cover sheet. You may also use the PAN medical claim fax cover sheet between every individual medical claim. Please do not fax any additional documentation such as welcome letters, clinical notes, fax confirmations or income verification documents with a claim.

After submitting a claim

Checking the status of submitted claims

You can verify receipt of claims, status, and payment details through the Luminare portal, or by calling PAN. To review processed claims and payment details, you may use the PAN portal. Note that to review a claim in your portal account, the tax ID and NPI on the claim must match the tax ID and NPI used to create the portal account.

Returned claims

A claim may be returned if the submitted claim is illegible, or the claim is missing required information for processing.

For reconsideration, update the reimbursement form with the correct information and resubmit a legible claim for reprocessing. Make sure you write “corrected claim” on the resubmission.

Processed and denied claims

If the claim was processed and denied, check the Explanation of Provider Payment (EPP) for the claim denial reason. If more information is required or you want the claim to be reconsidered, please update, and resubmit the claim with the original documents along with the required information and write “corrected claim” for reprocessing.

The most common reasons PAN may deny a provider claim include:

  • Duplicate claim submitted. If you are resubmitting a claim with updated information, please write “corrected claim” on top of the second claim submission.
  • Service code or diagnosis code is not covered. Please refer to our list of covered services, and verify if the diagnosis code and/or medication are covered under the disease fund.
  • A copy of the primary plan’s EOB was not submitted. Resubmit the claim form with a copy of the EOB from the insurance plan. If one is not available, contact us.
  • The member is not eligible. The grant was not effective on the date of service billed. If the date of service falls after the eligibility period, you can check the disease fund status to renew the grant, or contact us.

The full list of denied claim messages and remediation steps are provided on our claims help resources page. If you have questions about a denied claim, please securely message us in the PAN portal, contact us online, or call us at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET.

Extensions and grant reinstatement

We accept inquiries about extenuating circumstances and requests for grant reinstatement. Contact us via secure message on the PAN portal or call us at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET.

Learn about our grant use policy

Getting provider payments

Provider payments are sent by ECHO Health, PAN’s third-party healthcare payment vendor.

Payment methods

You have three payment options:

  1. QuicRemit virtual credit cards (the default method). No action needed.
  2. ACH transfers. You must email edi@echohealthinc.com to obtain the enrollment form.
  3. Paper checks. You must contact ECHO Health at 1-440-835-3511.

Explanation of provider payments (EPP) statements can be accessed electronically through the Luminare portal or on the ECHO portal at providerpayments.com. If the claims were processed electronically, you can access these statements through your clearinghouse via the 835 file.

Refunds

We accept refunds when the insurance company made an adjustment resulting in PAN overpayment of claims. We will adjust the grant accordingly. If the patient’s grant is no longer active, we will make the funding available for other recipients.

Send your refund check and the EPP to:

PAN Foundation
PO Box 2955
Clinton, IA 52733

Note: for adjustments, send the check if applicable, and the corrected EOB showing the adjustment.

Forms

Claims and billing help

If you need help with claims and billing, you can message us through your PAN portal, or call us at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET.