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)
BIN: 610020
PCN: MEDDPDM
Group #: (See below – New Rx Group # by program)

 

                                                    Effective 02/01/2016

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
99992666 HEPATITIS C 99992654 PSORIASIS
99992652 HEREDITARY ANGIOEDEMA 99992659 PSORIATIC ARTHRITIS
99992695 INFANTILE SPASMS 99992668 RENAL CELL CARCINOMA
99992685 IRON DEFICIENCY ANEMIA 99992655 RHEUMATOID ARTHRITIS
99992657 JUVENILE ARTHRITIS 99992694 SARCOIDOSIS
99992661 MELANOMA 99992664 SKIN AND SKIN STRUCTURE INFECTIONS
99992648 MULTIPLE SCLEROSIS 99992658 SYSTEMIC LUPUS ERYTHEMATOSUS
99992697 MYOSITIS 99992696 UVEITIS

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 #. 

For Example:

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 9:00am – 6:00pm, 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 9:00am – 6:00pm, 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 9:00am – 6:00pm, excluding holidays.