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Pharmacy Claims: Frequently Asked Questions

 

The Patient Access Network (PAN) Foundation contracts with Pharmacy Data Management, Inc. (PDMI), a third-party administrator, 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. How do I check claims and payment status?
  7. How can I receive faster claim payment?
  8. My claim was denied. What should I do?
  9. My patient’s grant has a minimum claim requirement and the submitted claim does not meet that minimum claim requirement. What should I do?
  10. Where should refunds be mailed? 
  11. Who can I contact for claims support?
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.

» RX BIN: 006012

» PCN for Part D: MEDDPDM

» PCN for all other payers: N/A

 

Note: PAN’s Proof of Expenditure forms are for direct member reimbursement (DMR) 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.

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:           1-866-316-7261

Mail:         PAN Foundation

PO Box 221858

                Charlotte, NC 28222

 

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

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. Payment is sent out weekly.

6. 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 https://pharmacyportal.panfoundation.org/.

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

7. 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.

8. 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.

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

If your patient’s submitted claim does not meet the minimum claim requirement, you can aggregate multiple claims to meet the requirement and file them manually.

 

More information on minimum claim requirements can be found on each disease fund page on the PAN website.

10. Where should refunds be mailed? 

Please submit refunds to the following address: 

 

PAN Foundation

Attn: Refunds

PO Box 221858

Charlotte, NC 28222

11. 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 5 p.m. ET.