Identification and authentication of providers are essential since Medicare's extensive system is vulnerable to fraud. As these organizations, providers, and patients depend on Medicare participation for their healthcare requirements, using a sequence of PTAN and NPI numbers in their appropriate areas helps healthcare organizations stay in compliance and safeguards Medicare from fraud and abuse. According to WPS, a provider's PTAN is identical to the Unique Provider Identification Number, or UPIN, that was once provided but is no longer in use. Providers must get a National Provider Identifier (NPI) before being approved for a PTAN to be included in the Health Insurance Portability and Accountability Act (HIPAA) standard procedure. A provider can send a finished provider enrollment application to the Provider Enrollment department of the Medicare Administrative Contractor after receiving their NPI. The MAC Provider Enrollment section issues a PTAN if it is authorized.
What Exactly Is a Provider Transaction Access Number (PTAN)?
When a provider enrolls in Medicare, they are granted a Provider Transaction Access Number (PTAN), which Medicare provides. This six-digit number is often allocated based on the service provided and the provider's location. The PTAN number allotted to Medicare Administrating Contracting (MAC) providers should appear in their acceptance letters after enrolment. The state of the provider or the provider's primary billing address is indicated by the first two digits of the issued code. For instance, the state codes for Connecticut and New York both start with 07. The complete set of codes broken down by state is available in the CMS State Operations Manual. The type of the institution, such as whether it is a skilled nursing facility, general hospital, or short-term facility, is represented by the next four numbers, or "series," of the PTAN number. If a letter appears in the series, either a general hospital or a short-term specialty facility operates there.
The state of the provider or the provider's primary billing address is indicated by the first two digits of the issued code. For instance, the state codes for Connecticut and New York both start with 07. The complete set of codes broken down by state is available in the CMS State Operations Manual. The next 4 digits of the PTAN number, referred to as a "series," represent the facility's category, such as whether it is a skilled nursing facility, general hospital, or short-term facility. If a letter appears in the series, the facility is either a general hospital or a short-term specialist facility.
Obtaining a Medicare PTAN
Here are some pointers for requesting a Medicare PTAN.
Apply for the NPI Number
You should first apply for your NPI number because you also require one. You may visit the National Plan & Provider Enumeration System (NPPES) website, create an account, and then follow the on-screen prompts and instructions to apply for an NPI number. Providers of healthcare services can also apply for an NPI number through Electronic File Interchange (EFI), which is carried out by businesses that are experts in that field.
The NPI Enumerator can be contacted for a copy of the NPI application form as the third option. You may also visit the application form on the CMS website and enter your information if you are a health provider. Mail inquiries to the NPI Enumerator at the following address:
- Enumerator of NPIs
- 7125 Ambassador Road, Suite 100
- Windsor Mill, MD 21244-2751
- Use this phone number to get in touch with the office: 800-465-3203. Additionally, the TTY number 1-800-692-2326 is accessible.
To contact customer support, send an email to [email protected]. Additionally, keep an eye out for confirmation mail from the same address. Through it, you will receive your NPI number. Check your spam or trash folder of mail if you can't view the message. Your information will be uploaded onto the NPPES platform as soon as the NPI Enumerator personnel has collected it. When requesting your NPI, remember to mention your taxonomy code. It specifies your categorization and specialty and is required to finish the application procedure.
Compile all the Required Information
You need to have additional information on hand in addition to your NPI number so you may fill out the application on whichever platform is appropriate. These details include things like your legal name or company name, fax number, and business number. You might also want your clinic's address. In addition, you might be required to submit a credit card when paying the application cost. A Provider Identification Number may also be required (PIN). So that you may complete everything at once, make sure to gather all the essential data before requesting a Medicare provider transaction access number.
Submit Your PTAN Application
You may access your PTAN in a variety of ways. Everything depends on whether or not the healthcare service provider for whom you work has already cooperated with Medicare. If you are a healthcare provider looking to partner with an existing Medicare-enrolled organization, you must look up the PTAN in the internet-based PECOS. You may log in to your PECOS account and go to My Associates>View Enrollments>View Medicare ID Report. If your healthcare service provider is approved, you can access the PTAN number. If your healthcare service provider does not already have a PTAN, you can enroll your business in the PECOS platform and acquire a new number.
If you request it in writing, the Medicare Provider Enrollment (PE) Department can also identify your PTAN. Your letter must be on the provider's letterhead and include your NPI and signature. If you desire an individual PTAN, you may only request the number on your behalf. And, if you desire a group PTAN, you must be permitted to do so. Another method is to contact the Medicare Administrative Contractor (MAC) and request a PTAN in writing on your firm letterhead. They will then handle your application. If you have previously enrolled in Medicare through your MAC, please refer to the notification letter you received from your MAC. However, be sure that you find the correct MAC for your region.
You may also receive your PTAN from the National Plan and Provider Enumeration System (NPPES). When searching for an NPI number, you may find your Medicare PTAN at the bottom of the National Provider Identifier (NPI) information screen. Even if you have an NPI, you cannot do business with Medicare without a PTAN. As a result, it is best to apply for it or retrieve your current number as quickly as feasible. Gather your information ahead of time to guarantee a smooth application procedure. Use legitimate credentials because you may need help to quit or save your work to seek them. Once you get the number, you may begin invoicing Medicare. Also, remember that if you do not bill Medicare for four quarters in a row, your number will be canceled.
Importance Of PTAN Number
Although the documentation required to get a PTAN number may appear cumbersome or complex for healthcare companies, tracking Medicare providers and suppliers via PTAN numbers benefits organizations in the long run by safeguarding them against fraudulent providers. Several tools are available to help administrators through the monitoring and compliance documentation required.
Three Steps to Finding Your PTAN
Here are three methods for locating your PTAN number:
- Refer to the letter received by your MAC after your Medicare enrollment was accepted.
- Access the PECOS website. Choose "My Enrollments" and then "View Enrollments." Find the relevant enrollment and click the "View Medicare ID Report" link. This will return to a list of all PTAN's active providers and suppliers. Your healthcare provider or supplier will be added to the list if authorized.
- You can send a signed, written request to your MAC on corporate letterhead. Include your legal or business name, NPI, phone and fax numbers, and email address.
NPI vs. PTAN Numbers: Differences
According to the Department of Health and Human Services (HHS), the Health Insurance Portability and Accountability Act uses the NPI as a national standard (HIPAA). The National Plan and Provider Enumeration System (NPPES), utilized by all health plans and healthcare clearinghouses for filing HIPAA standards transactions, issues the provider with a unique identifying number called an NPI. The PTAN contains information on the provider, whereas the NPI is a 10-digit number without that information. The NPI is meant to be used as an identifying number that may be shared with other providers and suppliers, insurance companies, clearinghouses, and any other organization requiring it for billing.
On the other hand, a PTAN is exclusive to Medicare and is given to providers when they sign up for the program. Therefore, a provider requires an NPI and a PTAN number to participate in Medicare. A provider may have several PTAN numbers, which indicate enrollment through many practices or Medicare contractors, even if the provider only has one NPI.
When using MAC self-help resources, an approved provider should utilize the PTAN to verify the provider and the NPI to charge the Medicare program. The provider or supplier in the Medicare program may be quickly recognized, and transactions can be traced using the NPI and PTAN numbers.
Medicare gives the PTAN number to authenticate the provider while accessing the local Medicare Administrative Contractors (MAC) self-help resources, such as the IVR, internet portal, online application status, etc., even though Medicare only requires the NPI number for claims filing. A physician will only ever have one NPI, but often each practice, group, or MAC to which she is affiliated will give her a unique PTAN. Medicare keeps a record of both numbers in its Provider Enrollment Chain & Ownership System and utilizes the NPI and PTAN to identify the provider in their programs (PECOS).