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Pharmacy Claims: Frequently Asked Questions

 

The Patient Access Network (PAN) Foundation contracts with DST Pharmacy Solutions to process pharmacy claims. Here are some of the commonly asked questions we receive from pharmacists about the claims submission process.

 

  1. What information do I need to submit a claim?
  2. What services are covered?
  3. How do I submit a claim to PAN?
  4. How long does it take for a claim to be processed?
  5. What are the payment methods for claims?
  6. What is the Grant Use Policy?
  7. How many claims do I need to submit per year to keep my grant active?
  8. Do I need to have a paid claim on file for the 120 days to start again?
  9. How do I check claims and payment status?
  10. How can I receive faster claims payment?
  11. My claim was denied. What should I do?
  12. My patient’s grant has a minimum claim threshold and the submitted claim does not meet that minimum claim threshold. What should I do?
  13. Where should refunds be mailed?
  14. Who can I contact for claims support?
  15. I am not currently in DST’s network. How can I join?
1. What information do I need to submit a claim?

» Billing ID Number, which contains numerals only, and can be found by visiting PAN’s Pharmacy Portal or calling 866-316-7263.

» Group Number, which varies by disease fund and is available in the Pharmacy Billing Guide.

» RX BIN: 610728

» PCN: PANF 

 

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

2. What services are covered?

PAN provides deductible, coinsurance and co-pay assistance. A full list of covered services can be found on each disease fund page on the PAN website.

 

The following items are not covered by PAN:

 

» Eligible medications not covered by the patient’s insurance.

» Eligible medications paid by the primary insurance payer at 100%.

» Eligible medications billed only to drug discount cards and not insurance.

» Medications not covered under PAN’s formulary for the corresponding disease fund.

3. How do I submit a claim to PAN?

You can submit claims electronically through your billing system. If you cannot bill PAN electronically, submit your claim manually on a Universal Claim Form (UB-92 or UB-40) by fax or mail using the contact information below:

 

Fax:         1-844-871-9753*

Mail         DST Pharmacy Solutions

                Dept.: 0756

                P.O. Box 419019

                Kansas City, MO  64141

 

Please refer to our Pharmacy Billing Guide for more information on how to submit a claim.

 

*If you used our old fax number by mistake, we will forward your fax to the right place.

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

Electronic claims are processed immediately. The standard processing time for manual 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.

5. What are the payment methods for claims?

There are two payment options for pharmacists: ACH transfers or paper checks. Payments are sent out weekly.

6. What is the Grant Use Policy?

PAN’s Grant Use Policy encourages grant recipients to use their grants as intended to help cover the out-of-pocket costs for critical medications. The patient, healthcare provider or pharmacist must request and receive payment for a claim from PAN within 120 days of the enrollment date. Throughout the patient’s eligibility period, you must submit one paid claim during each 120-day period.


If grant recipients do not follow the Grant Use Policy, their grants will be canceled, and the released funds will be used to provide grants to other patients who need assistance. If the patient needs assistance at a later date, you are welcome to reapply for assistance on their behalf, pending fund availability. If you have questions, please call us at 866-316-7263.


Please note that PAN grant recipients must be currently in treatment, scheduled to begin treatment in the next 120 days or have had treatment in the past 90 days. If the patient has extenuating circumstances, please let us know.

7. How many claims do I need to submit per year to keep my grant active?

There is no set number of claims that must be submitted per year. The patient, pharmacist or the healthcare provider must request and receive payment for a claim from PAN within 120 days of the enrollment date. Throughout the eligibility period, another claim must be received and paid within 120 days of the previous claim, or the grant will be cancelled.

8. Do I need to have a paid claim on file for the 120 days to start again?

Yes, there must be a paid claim on file in order for the 120 days to start again or you must have received an approved extension from PAN.

9. How do I check claims and payment status?

There are two ways to check claims and payment status:

 

» View payment details through the PAN Pharmacy Portal at pharmacyportal.panfoundation.org.

» Call PAN at 866-316-7263, Monday through Friday, 9 a.m. to 7 p.m. ET.

10. 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 10 business days.

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

If your claim was denied, we will provide you with a rejection code and denial reason. If additional information is required or you would like the claim to be reconsidered, please resubmit the claim with the requested information.

 

In addition, PAN has an appeals process that may be used in extenuating circumstances. We encourage you to contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. or 866-316-7263 if you would like to learn more.

12. My patient’s grant has a minimum claim threshold and the submitted claim does not meet that minimum claim threshold. What should I do?

Select disease funds have a minimum threshold for PAN to process the claim. You may combine multiple prescriptions to meet the minimum claim threshold. The following disease funds have a minimum claim threshold:

 

» Heart Failure: $25

» Parkinson’s Disease: $50

13. Where should refunds be mailed? 

Please submit refunds to the following address: 

 

           DST Pharmacy Solutions

Dept.: 0756

P.O. Box 419019

Kansas City, MO  64141

14. Who can I contact for claims support?

If you have questions about a claim, please contact PAN at 866-316-7263, Monday through Friday, from 9 a.m. to 7 p.m. ET.

 

If you have an urgent question outside of PAN’s call center hours, please contact the DST Pharmacy Solutions call center at 844-616-9448.

15. I am not currently in DST’s network. How can I join?

To join DST’s network, contact the DST pharmacy call center at 844-616-9448 or This email address is being protected from spambots. You need JavaScript enabled to view it..