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Medical Provider Claims: Frequently Asked Questions

 

 

 

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.

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. Where can I find a list of covered diagnosis codes?
  7. When can I renew a grant?
Claims
  1. What information do I need to submit a claim?
  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 verify my patient’s grant balance?
  6. How do I check claims and payment status?
  7. My claim was denied. What should I do?
  8. I resubmitted a claim and it was denied as a “duplicate claim.” What should I do?
  9. What if the patient’s grant does not meet the minimum claim threshold?
  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. Where should refunds be mailed?
  2. What are the payment methods for claims and how can I change my payment method?
  3. How do I change the location where my checks are mailed?
  4. What payment confirmation will I receive after I submit a claim?
  5. How can I receive faster claim payment?
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. I submitted a claim to the insurance company, and it is pending. What happens if I miss the deadline?
  5. Do I need to have a paid claim on file for the 120 days to start again?
Portal
  1. Does PAN have a provider portal and how can I access it?
  2. What if I have questions about the PAN Provider Portal?
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 provider portal at https://bit.ly/373xchW.

 

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. Where can I find a list of covered diagnosis codes?

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.

7. When can I renew a grant?

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

Claims

8. What information do I need to submit a claim?

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.

9. How do I submit a claim to 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.

10. 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.

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.

 

You may also use the PAN Medical Claim Fax Cover Sheet between every individual medical claim.

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

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

13. 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

» 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.

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.

18. What if I have more questions about claims?

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