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Medical Provider Claims: Frequently Asked Questions

 

 

 

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?
  2. How do I submit a claim to PAN?
  3. What if I have questions about submitting a claim?
  4. How can I submit more than one claim?
  5. How long does it take for a claim to be processed?
  6. What are the payment methods for claims?
  7. What is the Grant Use Policy?
  8. What if the patient’s treatment is only once or twice a year?
  9. I submitted a claim to the insurance company and it is pending. What happens if I miss the deadline?
  10. Do I need to have a paid claim on file for the 120 days to start again?
  11. How do I check claims and payment status?
  12. How can I receive faster claim payment?
  13. My claim was denied. What should I do?
  14. When I resubmitted my claim with all the required information, it was denied and marked as a “duplicate claim.” What should I do?
  15. Where can I find a listing of covered diagnosis codes?
  16. Where should refunds be mailed?
  17. What if I have questions about the PAN Provider Portal?
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 welcome letter.

» Group Number, which can be found on the patient’s PAN welcome 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 Direct Member Reimbursement (DMR) forms are for member reimbursement 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. You may also contact PAN at 866-316-7263, Monday through Friday, from 9 a.m. to 7 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. 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.

8. What if the patient’s treatment is only once or twice a year?

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 the 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 the 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.

9. 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.

10. 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.

11. How do I check claims and payment status?

There are two ways to check claims and payment status:

 

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

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

12. 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.

13. 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. 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.

 

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.

14. 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, be sure to write “Corrected Claim” at the top of the claim form so the PAN team knows that new information has been added.

15. 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.

16. Where should refunds be mailed?

Please submit refunds to the following address:

PAN Foundation

PO Box 2310

Mt. Clemens, MI, 48046

17. What if I have questions about the PAN Provider Portal?

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.