PAN Foundation Provider Webinar Series

Webinar 6| Medical Claims Portal

• Ayesha Azam, PAN Director of Provider Relations

• Jennifer Sliger, CoreSource Support Manager

PAN Foundation 2

Presenters

1. How to Use the Claims Portal

2. Why Were My Claims Denied?

3. How to Reconsider Your Claims

4. Where Can You Go for Claim Support?

5. Q&A

PAN Foundation 3

Agenda

Mission

To help underinsured people with life-threatening, chronic and rare diseases get the medications and

treatment they need by paying for their out-of-pocket costs and advocating for improved access and

affordability.

Vision Statement

We envision a nation in which everyone can get the health care they need.

PAN Foundation 4

Who We Are

How to Use the Claims Portal

PAN Foundation 5

PAN Foundation 6

Step 1: Register as a Provider at www.mycoresource.com

PAN Foundation 7

Step 1 (cont.): Register as a Provider at www.mycoresource.com

PAN Foundation 8

Step 1 (cont.): Register as a Provider at www.mycoresource.com

PAN Foundation 9

Step 2: Sign in to Your Account

PAN Foundation 10

Step 3: Search for Your Patient

Required search fields:1. Patient PAN ID or Social Security Number2. Patient first and last name3. Patient date of birth4. Patient gender

PAN Foundation 11

Step 4: Select Your Date of Service

PAN Foundation 12

Step 4 (cont.): Select Your Date of Service

PAN Foundation 13

Step 5: Review Your Explanation of Benefit

Claim Denial Reasons

PAN Foundation 14

EOB Denial Code Denial Reason Next Steps for Reconsideration

TF1 Timely filing period exceededReview patients eligibility to confirm the claim was sent

within the timely filing period.

003 Secondary payment cannot be issued. A copy of the

primary plan's EOB must be submitted to consider these charges.

Resubmit claim with a copy of the primary carrier’s EOB

PPE Primary carrier EOB needed Resubmit claim with a copy of the primary carrier’s EOB

}41 Secondary payment cannot be issued Resubmit claim that matches the primary carrier’s EOB

DUN Secondary payment cannot be issued Resubmit claim with an itemized primary carrier’s EOB

<44 Secondary payment cannot be issuedResubmit claim with a legible copy of the primary carrier’s

EOB

>44 Pharmacy label is missing Resubmit claim with the pharmacy label

PNFCharges are not covered when primary plan guidelines/requirements are not followed.

Confirm with the primary carrier that the denial was appropriate. If the primary carrier reconsiders the claim,

resubmit the claim and EOB for reconsideration.

%01Claim has been submitted with an ICD-9 diagnosis code,

which is invalid after 9/30/15Resubmit claim with the ICD-10 diagnosis code

%02Claim has been submitted with an ICD-10 diagnosis

code, which is invalid prior to 10/1/15Resubmit claim with the ICD-9 diagnosis code

CW9 Incomplete claim submissionResubmit claim with the requested medical record

information

PAN Foundation 15

Claim Denial Reasons

EOB Denial Code Denial Reason Next Steps for Reconsideration

%03 Invalid diagnosis code for DOS submitted. Review the diagnosis code billed to ensure accuracy

B10 The diagnosis code(s) reported are not covered Review the diagnosis code billed to ensure accuracy

CN5 The service code reported is not covered Review the service code billed to ensure accuracy

C03 Charges included in physicians surgery fee Review the service code billed to ensure accuracy

BE1The diagnosis and/or service codes reported are not

coveredReview the diagnosis/service code billed to ensure accuracy

( '44 )The charges billed do not meet the required criteria

for payment. No payment has been issued. Review the diagnosis/service code billed to ensure accuracy

ADDThis corrected claim is in the process of adjustment.

A corrected EOB is forthcoming.A corrected EOB will be forthcoming

099 Duplicate charge previously processedReview patient records to determine if payment was

received

-41The fund limit has exhausted for this benefit period.

No payment has been issued.Seek second grant if the fund is open and request for the

claim to be reconsidered

/41 Partial reimbursement issued-Fund limit exhaustedSeek second grant if the fund is open and request for the

claim to be reconsidered

PAN Foundation 16

Claim Denial Reasons

How to Reconsider Your Claims

PAN Foundation 17

PAN Foundation 18

Recommendation: Check Your Patient’s Eligibility

Recommendation: Send a Secure Message to Reconsider a Claim

PAN Foundation 19

• Electronic claim submission ensures clean claims.

» All required fields needed to adjudicate a claim are complete

» All primary coverage payments are provided

• Reduces turnaround time by 2 business days compared to faxing claims

Interested in signing up for electronic claim submission? Contact your billing vendor for more information.

PAN Foundation 20

Recommendation: Submit Claims Electronically

Claim Support

PAN Foundation 21

PAN Provider Portal: providerportal.panfoundation.org

CoreSource Portal: mycoresource.com

866-316-7263, Option #5

Monday – Friday 9 a.m. to 5 p.m. ET

PAN Foundation 22

Claim Support

Claim Support: 866-316-7263, Option #5

PAN Foundation 23

Q&A

Claim Status or Payment Questions

866-316-7263, Option #5

Ayesha Azam, Director of Provider Relations

202-347-4451

aazam@panfoundation.org

PAN Foundation 24

Contact Information