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Frequently asked questions for pharmacists

 

 

 

We contract with SS&C Health to process pharmacy claims. Here are some of the commonly asked questions we receive from pharmacists about the claim submission process.

Enrollment
  1. What services are covered?
  2. What services are not covered?
  3. Does my patient qualify for assistance?
  4. How do I apply for assistance?
  5. How long is a grant?
  6. When can I renew a grant?
  7. How do I verify my patient’s grant balance?
Claims
  1. I am not currently in SS&C Health’s network. How can I join?
  2. How do I submit a claim to PAN?
  3. How long does it take for a claim to be processed?
  4. How can I submit more than one claim?
  5. How do I check claims and payment status?
  6. My claim was denied. What should I do?
  7. How do I submit a claim to PAN if the date of service is beyond what my pharmacy system allows?
  8. What if the patient’s grant does not meet the minimum claim threshold?
  9. Who can I contact for claims support?
  10. Can I submit a claim after the patient’s grant period has ended?
  11. What if I have more questions about claims?
Reimbursement
  1. What is the payment method for claims?
  2. What payment confirmation will I receive after I submit a claim?
  3. Where should refunds be mailed?
Portals
  1. Does PAN have a pharmacy portal and how can I access it?
  2. What if I have questions about the PAN Pharmacy Portal?
Grant Use Policy
  1. What is the Grant Use Policy?
  2. How many claims do I need to submit per year to keep my grant active?
  3. What if my patient’s treatment is only once or twice a year?
  4. Do I need to have a paid claim on file for the 120 days to start again?
Second Grants
  1. Can I apply for more financial assistance after my patient exhausts their grant?
  2. What if my patient received a second grant but the previous claim was partially paid?

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Enrollment

1. What services are covered?

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.

2. What services are not covered?

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 https://bit.ly/373K3jU.

3. Does my patient qualify for assistance?

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.)

4. How do I apply for assistance?

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 on the pharmacy portal at https://bit.ly/375AAZt.

 

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.
5. How long is a grant? 

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.

6. When can I renew a grant?

Grants may be renewed starting 30 days before the eligibility period ends.

7. How do I verify my patient’s grant balance?

To verify the grant balance remaining in the patient’s account, please check the pharmacy portal or contact us.

Claims

8. I am not currently in SS&C Health’s network. How can I join?

You may join SS&C Health’s network by contacting SS&C Health at 844-616-9448 or This email address is being protected from spambots. You need JavaScript enabled to view it..

9. How do I submit a claim to PAN?

Electronic Claim Submissions

Electronic claims are processed immediately. To submit an electronic claim, please use the following billing information:

 

» Billing ID*: 10-digit numeric ID unique to each patient

» Rx BIN: 610728

» Rx Group: Refer to “Pharmacy Billing Guide”   

» Rx PCN: PANF

 

*PAN Billing ID number can be found on the welcome letter, by visiting PAN’s Pharmacy Portal or by calling 866-316-7263.

 

You can submit claims electronically through your billing system. If you cannot bill PAN electronically, you may submit manually by fax or mail.

 

Manual Claim Submissions

 

1. Please submit the following items:

» Completed Universal Claim Form or CMS-1500 form (see Pharmacy Billing Guide for an example).

» Corresponding Remittance Advice (RA) or Explanation of Benefit statement (EOB).

 

2. Fax or mail claim(s) to:

» Fax: 1-844-871-9753

» Mail: SS&C Health

             Dept.: 0756

             PO Box 419019

             Kansas City, MO 64141

10. 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 or illegible information may lead to delays in claim processing time.

11. How can I submit more than one claim?

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.

12. 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.

13. 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 (see Pharmacy Billing Guide to learn more).

 

In addition, PAN has an appeal process that may be used in extenuating circumstances. We encourage you to contact us at 866-316-7263 if you would like to learn more.

14. How do I submit a claim to PAN if the date of service is beyond what my pharmacy system allows?

If the pharmacy system does not allow you to resubmit a claim to PAN after a certain number of days, please manually submit the claim and provide the corresponding remittance advice from the insurance, along with a Universal claim Form or CMS-1500 form (see Pharmacy Billing Guide for an example).

15. What if the patient’s grant does not meet the minimum claim threshold?

Select disease funds have a minimum threshold requirement 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

 

If your claim must be aggregated because it does not meet the minimum claim requirements, please submit the claim manually.

16. Who can I contact for claims support?

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

 

If you have an urgent question outside of PAN’s call center hours, please contact the SS&C Health call center at 844-616-9448.

17. Can I submit a claim after my patient’s grant period has ended?

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.

18. What if I have more questions about claims?

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

Reimbursement

19. What is the payment method for claims?

SS&C Health payments are issued via electronic funds transfer (EFT) and paper checks. SS&C Health payment cycles are twice a month and are issued on the 16th and the last day of each month. For additional information, contact the SS&C Health reconciliation team at 866-211-9459 or This email address is being protected from spambots. You need JavaScript enabled to view it..

20. What payment confirmation will I receive after I submit a claim?

SS&C Health provides electronic remittance advice once the claim has been processed. The remittance advice is accessible at www.argushealth.com/login. Please see the Pharmacy Billing Guide for instructions on how you can access the payment portal if you do not have an account. SS&C Health does not issue paper remittance advice.

21. Where should refunds be mailed?

SS&C Health does not accept refund checks.

 

» For Single Claim Adjustments: contact the SS&C Health Help Desk at 844-616-9448.

 

» For Multiple Claim Adjustments (5 or more claims): please visit https://www.argushealth.com/myargus/MyArgus and complete the Multiple Adjustments Request Form or click here to obtain the form. Please see the Claims Adjustments section of the Pharmacy Billing Guide for more information.

 

Any adjustment transactions will be reflected in the next pay cycle.

Portals

22. Does PAN have a pharmacy portal and how can I access it?

Yes, PAN has a portal to assist pharmacy users. To access the portal, visit https://pharmacyportal.panfoundation.org/.

23. What if I have questions about the PAN Pharmacy Portal?

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

 

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

24. 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 or extenuating circumstances, please call us at 866-316-7263.

25. 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. However, you must request and receive payment for a claim from PAN during each 120-day period. Please see question 24 to learn more.

26. What if my 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 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. 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 been approved for an extension from PAN.

Second Grants

28. Can I apply for more financial assistance after my patient exhausts their grant?

If your patient’s grant is exhausted during their 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://pharmacyportal.panfoundation.org/ or call us at 866-316-7263 to see if your patient qualifies.

29. What if my patient received a second grant but the previous claim was partially paid?

If a previous claim was partially paid, you may reverse and reprocess the claim for the full patient responsibility after the second grant is awarded.