FAQs for Providers
Who can apply on behalf of a patient, and what type of information is necessary to do so?
Providers, case managers, caregivers, patients, and patient advocates can apply on behalf of a patient. Applications can be received online, by telephone, facsimile or mail. In doing so, it is necessary to obtain patient contact information (name, address, phone number, date of birth), patient insurance and prescription information, and patient income information (household size and household income). Go to AssistFund eEnroll to apply on behalf of a patient.
How do I bill The Assistance Fund?
If you are a pharmacy, The Assistance Fund’s preferred method of billing is with electronic billing information. PDMI will issue appropriate claims processing information to support the cost of the patient’s claim. This information is as follows:
Customer / Card ID: Provided by The Assistance Fund (See below section “for Processing card ID #’s)
Group #: (See below – New Rx Group # by program)
The Assistance Fund Implements Changes to Rx Group #’s and Card ID Structure for PDMI Claims
For Processing Rx Group #’s:
Currently: All Rx Group information used to submit claims under bin 610020 is #99990607
New process: Rx Group #’s will be program- specific with the last four (4) digits varying by fund:
|NEW RX GROUP #’s||FUND NAME||NEW RX GROUP #’s||FUND NAME|
|99992656||ANKYLOSING SPONDYLITIS||99992693||NEPHROTIC SYNDROME|
|99992667||BREAST CANCER||99992662||NEUROENDOCRINE TUMORS|
|99992651||CLOSTRIDIUM DIFFICILE CDAD||99992665||NON SMALL CELL LUNG CANCER|
|99992650||CYSTIC FIBROSIS||99992663||PARATHYROID DISEASE|
|99992660||DIGESTIVE MOTILITY MALABSORPTION||99992649||PARKINSON’S DISEASE|
|99992652||HEREDITARY ANGIOEDEMA||99992659||PSORIATIC ARTHRITIS|
|99992695||INFANTILE SPASMS||99992668||RENAL CELL CARCINOMA|
|99992685||IRON DEFICIENCY ANEMIA||99992655||RHEUMATOID ARTHRITIS|
|99992661||MELANOMA||99992664||SKIN AND SKIN STRUCTURE INFECTIONS|
|99992648||MULTIPLE SCLEROSIS||99992658||SYSTEMIC LUPUS ERYTHEMATOSUS|
For Processing Card ID #’s:
Card ID #’s will expand to include the same program-specific four (4) digits underlined above. These numbers will precede the existing Card ID #.
An existing patient’s Card ID# is currently 00001. Patient is active in the Multiple Sclerosis Fund. The last four digits of the Multiple Sclerosis Rx Group # is 2648. Therefore the new patient Card ID # will be 264800001.
If you experience difficulty in processing claims, please call the PDMI help desk at: 1-800-800-7364
New Assistance Fund Program Cards are being processed and will be mailed directly to the patients.
In order to determine a patient’s remaining copay responsibility as well as obtain patient’s member benefits with our program, please contact a Patient Advocate at (855) 845-3663. Patient Advocates are available Monday through Friday from 9 am – 6 pm EST, excluding holidays.
For pharmacies that are unable to support electronic billing information or a claims adjudication system, payments can also be facilitated through a Visa E-Card. To establish an E-Card or set up a payment for your patient, please contact a Patient Advocate at (855) 845-3663. Patient Advocates are available Monday through Friday from 9 am–6 pm EST, excluding holidays.
If you are a Healthcare Provider or a Site of Care, The Assistance Fund accepts Explanation of Benefits. For healthcare providers who are administering a prescription medication at their site, payments are facilitated through a Visa E-Card. To establish an E-Card or set up a payment for your patient, please contact a Patient Advocate at (855) 845-3663. Patient Advocates are available Monday through Friday from 9 am – 6 pm EST, excluding holidays.