The Medicare revalidation process has prompted questions from physicians about the differences between the National Provider Identifier (NPI) and the Provider Transaction Access Number (PTAN), says the Centers for Medicare & Medicaid Services (CMS).
Here's a quick clarification:
| |
|
National Provider Identifier |
|
|
|
|
Provider Transaction Access Number |
| What |
|
Your national, unique identification number
(10 digits) |
|
|
|
|
A Medicare-only number |
| |
|
|
|
|
|
|
|
| Issued By |
|
National Plan and Provider Enumeration System |
|
|
|
|
Novitas, upon enrollment to Medicare (found in the enrollment approval letter). Or, Log into PECOS. Click on "My Enrollments," then "View Enrollments." Locate the applicable enrollment and click on the "View Medicare ID Report" link, which will list all your active PTANs in one report. |
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| Used For |
|
Billing Medicare. You, health plans, and clearinghouses must use it for HIPAA (electronic) transactions. |
|
|
|
|
Authenticating your identity when using Novitas self-help tools such as the automated phone system, Internet portal, or online application status. |
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| How Many |
|
One individual NPI per physician |
|
|
|
|
One or more, representing your enrollment. If you have relationships with one or more medical groups or practices or with multiple Medicare contractors, Novitas generally assigns separate PTANS. |
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| Shared? |
|
Yes. You must share it with others who need it for billing purposes. The NPI does not carry information such as the state where you live or your medical specialty, to reduce the chances of insurance fraud. |
|
|
|
|
Generally, no. You generally limit your PTAN's use to your contacts with Novitas. |
| |
|
|
|
|
|
|
|
Together, the NPI and PTAN identify you in the Medicare program. CMS maintains both the NPI and the PTAN in its master Provider Enrollment Chain and Ownership System (PECOS).
Remember, when you receive your revalidation notification letter from Novitas, you must submit your revalidation application within 45 days electronically or 60 days on paper, or your billing privileges may be deactivated. TMA encourages physicians to use Internet-based PECOS for revalidation, as PECOS applications process more quickly than paper applications.
Some Tips Regarding PTANs
- In section 1A of the CMS-855 application form, provide ALL active PTANs even if all active PTANs are not disclosed on the revalidation letter. Do not submit a separate application for each PTAN.
- If you want to revalidate some of the PTANs on the revalidation letter but voluntarily terminate or deactivate others, list only the PTANs you want to remain active on your CMS-855 application. If Novitas finds additional active PTANs in its system records that are not listed on the application, Notivas will call you/your designated contact person to confirm if you want to voluntarily terminate/deactivate the undisclosed PTANs. Upon confirmation, Novitas will use the date the application was signed as the effective date of termination for those PTANs.
When completing the revalidation form, please be sure that all fields are filled out completely and accurately, and track the application through completion via the Novitas online enrollment status tool. Novitas says it is having to ask for more information (see the top missing info) on some 80 percent of revalidation paper applications and 40 percent of revalidation web applications. See also Novitas' Revalidation Helpful Hints/Reminders and FAQs, as well as PECOS FAQs (PDF) from CMS.
Remember to visit TMA's Medicare Resource Center for useful links, tips, and information about enrollment, payment, and more.
Published Sept. 24, 2014
TMA Practice E-Tips main page
Last Updated On
May 13, 2016
Originally Published On
September 23, 2014