Frequently asked questions for healthcare providers
We contract with Trustmark Benefits to process medical claims. Here are some of the commonly asked questions we receive from providers about the claim submission process.
- What services are covered?
- What services are not covered?
- Does my patient qualify for assistance?
- How do I apply for assistance?
- How long is a grant?
- Where can I find a list of covered diagnosis codes?
- When can I renew a grant?
- What information do I need to submit a claim?
- How do I submit a claim to PAN?
- How long does it take for a claim to be processed?
- How can I submit more than one claim?
- How do I verify my patient’s grant balance?
- How do I check claims and payment status?
- My claim was denied. What should I do?
- I resubmitted a claim and it was denied as a “duplicate claim.” What should I do?
- Can I submit a claim after the patient’s grant period has ended?
- What if I have more questions about claims?
- Where should refunds be mailed?
- What are the payment methods for claims and how can I change my payment method?
- How do I change the location where my checks are mailed?
- What payment confirmation will I receive after I submit a claim?
- How can I receive faster claim payment?
Grant Use Policy
- What is the Grant Use Policy?
- How many claims do I need to submit per year to keep my grant active?
- What if my patient’s treatment is only once or twice a year?
- I submitted a claim to the insurance company, and it is pending. What happens if I miss the deadline?
- Do I need to have a paid claim on file for the 120 days to start again?
- Does PAN have a provider portal and how can I access it?
- What if I have questions about the PAN Provider Portal?
- Can I apply for more financial assistance after my patient exhausts their grant?
- What if my patient received a second grant but the previous claim was partially paid?
PAN is the payer of last resort, so all patients must be insured, and their insurance must cover the medication or supply for which the patient seeks assistance.
PAN provides reimbursement in the form of grants for deductible, co-payment and coinsurance amounts for medications or supplies on our formulary. A full list of covered medications and supplies can be found on the PAN website.
A few assistance programs cover insurance premiums, as well as ancillary travel expenses incurred while traveling to receive medical treatments.
The following items are not reimbursable by PAN:
» Eligible medications or over-the-counter products not covered by the patient’s insurance.
» Eligible medications paid by the insurance payer at 100%.
» Eligible medications billed only to drug discount cards and not insurance.
» Medical services, such as lab work, preventative vaccinations, diagnostic testing, genetic testing, ER visits and office visits.
» Medications not covered under PAN’s formulary for the corresponding disease fund.
Patients must meet the following criteria to be eligible for PAN assistance:
» The patient must be getting treatment for the disease named in the assistance program to which he or she is applying.
» The patient must have health insurance that covers his or her qualifying medication or product.
» The patient’s medication or product must be listed on PAN’s list of covered medications.
» The patient’s income must fall at or below the Federal Poverty Level specified by the assistance program. Visit our assistance programs to learn more about each fund’s income requirements.
» The patient must reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)
You will need the following information to apply:
- Patient’s demographic information (name, address, phone number).
- Diagnosis and medication name(s).
- Patient’s health insurance information.
- Patient’s income and number of people in the household.
- Physician and facility’s contact information.
Each grant eligibility period is 12 months. However, first time grant enrollees to a disease fund will have a 90-day look back period to cover qualified claims incurred prior to enrollment.
Covered diagnosis codes can be found on each disease fund page on the PAN website. To see a full list of the disease funds, please refer to Assistance Programs under the Patient tab.
Grants may be renewed starting 30 days before the eligibility period ends.
Gather, complete and submit the following items:
» W-9 form (required annually for each practice).
» Corresponding itemized primary and secondary (if applicable) Explanation of Benefits (EOB) or Medicare Remittance Advice (RA), showing payment by the insurance.
» For DRG/APC claims, please ensure the EOB is itemized. If you cannot get an itemized EOB, please contact PAN.
Electronic Claim Submissions
Electronic claims can be submitted through your payment system. To submit an electronic claim, please use the following billing information:
» Payer ID: 38225 (Payer ID is tied to NGS American)
» Billing ID: 10-digit numeric ID unique to each patient
Manual Claim Submissions
Submit manual claims by mail, fax or through our Provider Portal.
» Mail: PAN Foundation
PO Box 2310
Mt. Clemens, MI 48046
» Fax: 1-844-726-4728
» Portal: providerportal.panfoundation.org
Note: PAN’s Direct Member Reimbursement (DMR) forms are for member reimbursement only.
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.
When faxing or mailing multiple claims, each claim must have its own claim form and EOB/RA statement. Please separate claims with a blank page or fax cover sheet to ensure each claim is processed correctly.
You may also use the PAN Medical Claim Fax Cover Sheet between every individual medical claim.
To verify the grant balance remaining in the patient’s account, please check the provider portal or contact us.
There are two ways to check claims and payment status:
» View payment details through the PAN Provider Portal at providerportal.panfoundation.org
» Verify receipt of clean claims and payment statuses by calling PAN at 866-316-7263, Monday through Friday, 9 a.m. to 7 p.m. ET.
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 the original documents along with the required information (see Provider Billing Guide to learn more).
PAN has an appeal process that may be used in extenuating circumstances. We encourage you to contact us via secure messaging on the portal or 866-316-7263 if you would like to learn more.
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.
At the end of the patient’s grant period, you have 60 days to submit any outstanding claims with dates of services that are within the eligibility period.
Please submit refunds to the following address:
PO Box 2310
Mt. Clemens, MI, 48046
There are three payment options for providers:
» QuicRemit virtual credit cards
» ACH transfers
» 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 begin receiving payments with paper checks or QuicRemit virtual credit cards, please contact ECHO Health, PAN’s third-party healthcare payment vendor, at 440-835-3511, Monday through Friday, 8:30 a.m. to 6 p.m. ET.
To change the location of where checks are forwarded, please indicate the address in box 33 of the CMS claim form or in box 2 of the UB04 claim form. The tax ID must correspond to the address.
For faster payment, we recommend submitting claims electronically. Electronic 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 (See electronic claim submission for payer ID).
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 or extenuating circumstances, please call us at 866-316-7263.
There is no set number of claims that must be submitted per year. However, you must request and receive payment for a claim from PAN during each 120-day period. Please see question 24 to learn more.
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. We recognize that your patient’s treatment may not fit within the 120-day timeframes of the Grant Use Policy. If their treatment is only once or twice a year, and you or your patient receives a letter from PAN indicating that their grant must be used soon, please call us at 866-316-7263. We will take this under consideration.
27. I submitted a claim to the insurance company, and it is pending. What happens if I miss the deadline?
If the insurance company is still reviewing your claim and you are concerned about missing the 120-day deadline, please call us at 866-316-7263 and let us know before the 120th day. We will take this under consideration.
Yes, there must be a paid claim on file in order for the 120 days to start again, or you must have been approved for an extension from PAN.
Yes, PAN has a portal to assist provider users. To access the portal, visit https://providerportal.panfoundation.org.
If you have questions about the PAN Provider Portal, please contact PAN at 866-316-7263, Monday through Friday, from 9 a.m. to 7 p.m. ET.
If your patient’s grant is exhausted during the eligibility period, you may apply for additional assistance called Second Grants. To qualify, the current grant balance must be $0, and the disease fund must be open. Simply go to https://providerportal.panfoundation.org or call us at 866-316-7263 to see if your patient qualifies.