Provider FAQs

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.

Medication not covered? Call us at 1-866-316-7263 or submit a request at Find a 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.)

To apply for assistance, please call us Monday through Friday from 9 a.m. to 7 p.m. ET at 1-866-316-7263 or log in to the provider portal.

You will need the following information to apply:

1. Patient’s demographic information (name, address, phone number).
2. Diagnosis and medication name(s).
3. Patient’s health insurance information.
4. Patient’s income and number of people in the household.
5. 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. Visit the Find a disease fund page to see our full list of programs.

A renewal grant can be awarded after the grant period has ended, starting a new eligibility period for use. You may apply to renew a grant up to thirty days before the current grant period ends, even if there is still a grant balance remaining. Patients may start using renewal grants, if awarded, in the next grant period.

Please note: This is different than a second grant, which can only be awarded if the full value of the original grant is used and there is time remaining in a patient’s eligibility period. See question 31 for more information.

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).

• CMS-1500, UB-92 or UB-04 form.
• 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 Trustmark Health Benefits)
• 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
  Box 2310
  Clemens, MI 48046
• Fax: 1-844-726-4728
• Portal: https://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 call us at 866-316-7263, Monday through Friday, 9 a.m. to 7 p.m. ET.

There are two ways to check claims and payment status:

• View payment details through the provider portal.
• Verify receipt of clean claims and payment statuses by calling us 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).

We have 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 we know 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.

If you have more questions about claims, please refer to the Provider Billing Guide or call us at 866-316-7263, Monday through Friday, from 9 a.m. to 7 p.m. ET.

Please submit refunds to the following address:

PAN Foundation
Box 2310
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.

If you would like to receive payments with ACH transfers, please email edi@echohealthinc.com to obtain the enrollment form.

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.

You can view your explanation of provider payments (EPP) electronically at www.mytrustmarkbenefits.com or on the ECHO portal at www.providerpayments.com.

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 question 9 for information on electronic claim submissions).

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 23 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.

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 120^th 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, we have a portal specifically for healthcare providers. Log in or create an account today.

If you have questions about the provider portal, please call us at 866-316-7263, Monday through Friday, from 9 a.m. to 7 p.m. ET.

A second grant can be awarded if the patient’s grant balance is depleted before their eligibility period ends. If approved, the patient will be able to use funding from the second grant during the remainder of their eligibility period.

To qualify, the current grant balance must be $0, and the disease fund must be open. Simply go to the pharmacy portal or call us at 866-316-7261 to see if your patient qualifies.

Please note: This is different than a renewal grant, which can be awarded for use in a new eligibility period. See question seven for more information.

If your patient’s grant is exhausted during the eligibility period, you may apply for additional assistance, called a second grant. To qualify, the current grant balance must be $0, and the disease fund must be open. Simply log in to the provider portal or call us at 866-316-7261 to see if your patient qualifies.

If a previous claim was partially paid, we will reprocess the claim once the second grant is awarded. The claim will not need to be resubmitted.

The Disease Fund Wait List is a list of patients waiting to apply for assistance from a closed co-pay, travel or premium disease fund at the PAN Foundation. Patients may add themselves to the wait list or be added by their healthcare provider, pharmacy or caregiver. All patients or the individual acting on their behalf must provide a valid email address in order to sign up for the wait list.

The wait list enhances our ability to serve patients on a first-come, first-served basis by giving those on the wait list the first opportunities to apply for assistance when a fund opens.

When funding becomes available for a specific disease fund, individuals on the Disease Fund Wait List will be notified by email that the fund is open for applications—this is the period that a fund is considered to be in wait list status. The individuals on the wait list have the opportunity to apply before the general public during the wait list status.

Each disease fund that is closed has a wait list. Patients may add themselves to the wait list or be added by their healthcare provider, pharmacy or caregiver. There is no limit to the number of people who can be on the wait list at any given time.

Each patient on the wait list will be assigned a number corresponding to the order in which they were added to the list. Your patient’s number on the wait list will not be publicly available through the portals or by calling us by phone.

The entire process from the time the fund opens for application to notification of a successful grant takes four business days. Here’s a look at the overall timeline:

Business day 1:

• When we have secured funding for a closed disease fund, we will open that disease fund in wait-list status, and those on the wait list will get an email inviting them to apply for assistance with a unique URL and Wait list ID. Applications can be submitted via the portal or by calling PAN.
• The application period is open for two business days. At the end of the two-business day period, we will no longer accept applications from the wait list.

Business day 2:

• At the end of the two-business day period, we will no longer accept applications from the wait list.

Business day 3:

• The application period is now closed.

Business day 4:

• Within four business days, the patient, caregiver, provider or pharmacist will be notified by email whether a grant will be awarded.
• If your patient is awarded a grant, they can begin to use their grant immediately.
• If your patient is not awarded a grant due to insufficient funds, they will stay on the wait list, but move closer to the top. They will not lose their place on the wait list. They will be notified the next time the disease fund opens in wait-list status and will need to submit an application again.

Before signing up for the disease fund waitlist, check the eligibility criteria for the fund, including insurance and income requirements.

Note: the eligibility criteria vary based on disease fund.

Patients, caregivers, providers and pharmacists can add a patient’s name to the wait list through our portals, by visiting the specific disease fund page on the PAN website or by calling us at 1-866-316-7263.

Please note that the email address used when signing up for the wait list will also be used to provide updates on the fund’s status. We encourage you to ensure that the email address is checked often.

For the quickest way to add your patients to the wait list, log in to our provider portal. Reference our step-by-step instructions on how to sign your patient up for the wait list on the portals.

If your patients need assistance from a closed disease fund, we encourage you to sign them up for the wait list. You must sign each patient up for the wait list individually.

When a PAN disease fund is closed, the PAN website will always have up-to-date referrals if there is an open program at another foundation. We also encourage you to sign up and follow funds on FundFinder for instant alerts when a disease fund opens at any of the charitable patient assistance foundations.

If your patient no longer needs help, contact us by phone at 1-866-316-7263 to remove their name from the wait list or send us a secure message on your portal.

If you applied on behalf of your patient, you will receive an email confirmation that they have been added to the wait list.

You can also log in to the provider portal to confirm your patient’s placement on the wait list. Simply select “Disease Fund Wait List,” and scroll to the specific disease fund to select “See list.” The portal will display all associated patients that have been enrolled on a wait list by their healthcare provider.

When a closed disease fund moves into wait-list status, patients on the wait list will receive an email inviting them to apply. You will receive the invite to apply if you provided your email address on behalf of your patient when adding them to the wait list. Once the email goes out, people on the list will have two business days to apply for assistance.

The email will include a unique URL and wait list ID which will be required to apply for assistance from the wait list.

There are two ways to submit an application on behalf of your patient:

• Provider portal:
  When you click the unique URL in the invitation email, you will be directed to the provider portal and can continue the application process as normal on behalf of your patient. The portal is available 24/7.

• Phone: 1-866-316-7263
  Your email also includes a wait list ID for your patient. When you call us to apply, please have that wait list ID at the ready for the representative and they will be able to assist you through the application process.

Once we receive all applications at the end of the two business days, you will be notified by email within another two business days whether a grant can be awarded.

You are welcome to add your patient to a wait list even if a program is open at another foundation. However, we recommend that you contact the open program to ensure your patients can find assistance as quickly as possible.

PAN’s Disease Fund Wait List is a list of patients waiting to apply for assistance from a closed fund at PAN. When a closed PAN fund goes into wait list status, patients on the wait list will receive an email inviting them to submit an application to PAN.

FundFinder is a tool that tracks the availability of funding across 9 charitable organizations, including PAN. With FundFinder, you can sign up for email or text message notifications to learn when financial assistance becomes available for a specific diagnosis at any foundation.

We encourage you to sign up and follow funds on FundFinder for instant alerts when a disease fund opens at any of the charitable patient assistance foundations.

For answers to frequently asked questions, refer to this guide or read our step-by-step instructions on how to sign up and apply from the wait list.