Laying the foundation for principal illness navigation (PIN) billing in a virtual oral anticancer medication (OAM) navigation program: Phase 1 feasibility and process development.

47 Background: Oral anti-cancer medications (OAM) require patients to manage complex treatment plans, including adherence, refill coordination, and side effect reporting. Navigation programs are well-positioned to support these patients, but sustainability remains a barrier to scale. The introduction of Principal Illness Navigation (PIN) billing codes offers a potential path to sustain these services, yet few models show real-world integration. This project describes the feasibility and process development phase (Phase 1) of a virtual OAM navigation program designed to evaluate whether PIN billing could be successfully embedded into workflows prior to full program implementation. Purpose: Phase 1 tested the viability of PIN billing integration within a virtual OAM navigation model, focusing on process design, documentation standards, patient identification, and billing feasibility. This phase was conducted with a single nurse navigator (“pre-pilot”) to establish proof of concept prior to expanding to a full navigation team. Methods: Patient population: Individuals prescribed a new OAM across a multi-site oncology practice. Navigation conducted by a single nurse navigator during the feasibility phase. Development of eligibility criteria, documentation standards, and billing workflows aligned to PIN billing requirements. Use of task-based workflows, billing audits, and feedback loops. Establishment of success metrics to inform phase 2 scale-up. Results: Over 120 unique charges for 61 patients during Phase 1 pre-pilot testing by a single nurse navigator. Over 90% of patients incurred no out-of-pocket cost, with secondary insurance or supplemental coverage absorbing co-pays. Among the few patients having financial responsibility, average out-of-pocket cost was about $13 per month. Documentation workflows, eligibility screening, and billing processes were operationalized within the virtual model. Findings confirm that PIN billing integration is feasible prior to full program scale-up. Conclusions: This feasibility phase demonstrates that PIN billing can be successfully integrated into a navigation program through intentional process design and structured workflows. Billing capture during the pre-pilot phase supported leadership engagement and established a scalable model for sustaining navigation services without adding clinical team burden. Phase 2 will expand implementation across the multi-site practice with increased navigator staffing and evaluation of patient-centered outcomes and value-based care measures. These findings provide actionable insights for oncology leadership and physician stakeholders seeking sustainable navigation models that align with value-based care priorities, reduce operational strain, and support high-quality care delivery.