Because Medicare’s vast system is prone to fraud, it is crucial to know and verify providers. Because these businesses, suppliers, and consumers rely on Medicare involvement for their healthcare requirements, using a pair of PTAN and NPI numbers in their respective positions helps the healthcare institutions remain in line and protects Medicare from corruption and theft.
Providers and suppliers who have received queries to reverify their enrollment information had also asked CMS to clarify the distinctions between a national provider identifier (NPI) and a provider transaction access number (PTAN). An NPI is required for all entities offering services and charging Medicare for services given to Medicare enrollees. A PTAN will be provided to the physician or supplier upon submission to a Medicare supplier. Whereas only NPI can be presented on requests, the PTAN is a significant number directly connected to the NPI of the service or supplier.
Different PTANs are typically assigned if the practitioner has partnerships with one or more medical organizations or clinics or with numerous Medicare vendors. The NPI and PTAN, when combined, define the clinician or supplier in the Medicare and Medicaid programs.
What is a Provider Transaction Access Number (PTAN)?
Although the documentation may appear onerous or complicated, it is vital to prevent fraud by tracking Medicare providers and suppliers. A PTAN identifier is simply one method that federal aid may be tracked and patients safeguarded. There are several tools available to help administrators through the monitoring and compliance documentation required.
The Provider Transaction Access Number (PTAN) is a Government healthcare-issued number assigned to providers when they join Medicare. This identifier is generally six digits long and is assigned according to the kind of service and the provider’s location. Medicare Administrative Contractor (MAC) suppliers should get their allotted PTAN id in their acceptance letter upon enrolment.
The first two digits of the given code represent the provider’s region or the province of the provider’s principal billing address. For instance, New York’s state code is 33, while Connecticut’s state code is 07. The CMS State Operations Manual has a complete list of codes organized by state.
The next four digits of the PTAN number, referred to as a “series,” reflect the type of facilities, such as a quick facility, medical clinic, or certified nursing home. If a letter is included in the series, the institution is either a short-term specialty facility or a regular hospital.
How to Find Your PTAN Number?
Here are three methods for locating your PTAN number:
- Refer to the notice letter received by your MAC after your Medicare enrollment was accepted.
- Access the PECOS website. Click on “My Enrollments,” then “View Enrollments.” Locate the relevant enrollment and click the “View Medicare ID Report” button. This will return a list of all PTAN’s active services. Your healthcare provider or vendor will be added to the list if authorized.
- Send a notarized, formal request to your MAC on corporate letterhead. Provide your legal name or business name, national provider identification (NPI), phone and fax numbers, and email address.
What is the Relation Between NPI and PTAN?
CMS keeps track of both numbers, which are essential to enroll in Medicare. The NPI number assigned to a provider, on the other hand, is a single unique identification provided by CMS’s National Plan and Provider Enumeration System to comply with HIPAA Administrative Simplification standards. PTAN, on the other hand, is Medicare-specific. A supplier will then have one NPI; however, they may have several PTANs (s). If a physician is linked with various medical organizations, practices, or medical contractors, the physician may have numerous PTAN numbers.
What is the Difference Between NPI and PTAN?
The NPI is a federal mandate under the Health Insurance Portability and Accountability Act, per the Department of Health and Human Services (HIPAA). The NPI of the provider is a one-of-a-kind identifying number provided by the National Plan and Provider Enumeration System (NPPES), which is utilized by all health plans and health care intermediaries when reporting HIPAA standards transactions.
The NPI is a 10-digit number that does not include any provider information. The NPI is designed to be shared as an identifying number with other suppliers and providers, health care plans, clearinghouses, and any other institution that may require it for monitoring and billing.
A PTAN, on the other hand, is exclusive to Medicare and is granted to providers when they participate in the program. As a result, in order to participate in Medicare, a provider must have both an NPI and a PTAN number. While a practitioner has a single NPI, he or she may have numerous PTAN numbers, indicating enrollment in various practices or with multiple Medicare vendors.
While using MAC self-help resources, an authorized person should utilize the NPI to charge the Medicare program and the PTAN to verify the provider. The NPI and PTAN numbers allow the provider or supplier in the Medicare program to be recognized and track the activities.
Conclusion
While federal law (HIPAA) requires all providers to have a single unique NPI number that may be used in all administrative and financial transactions between providers and health insurers, Medicare providers additionally require a PTAN. So why do they need both?
While Medicare only requires the NPI number for claims processing, Medicare assigns the PTAN number to validate the provider while using the local Medicare Administrative Contractors (MAC) self-help resources such as the IVR, web platform, online registration status, and so on.
A provider must only have one NPI, but she will be allocated a distinct PTAN for each practice, group, or MAC with which she is affiliated. Medicare uses both the NPI and the PTAN to identify providers in their programs and keeps a record of both numbers in their Provider Enrollment Chain & Ownership System (PECOS).
Medicare requires providers to revalidate their enrollment information and must have both their National Provider Identifier (NPI) and their Provider Transaction Access Number (PTAN) to complete the procedure.
