Navigating the complex field of Medicare is a challenge for both patients and medical providers. Continued advances in medicine continuously change the rules and regulations behind Medicare. Obtaining a provider transaction access number (PTAN) is necessary for all health care providers who provide services to Medicare patients. This identifier is used to bill Medicare for medical services provided. Without a PTAN number medical provider billings to Medicare will be rejected and returned.
Provider Transaction Access Number (PTAN)
Obtain the necessary application forms to apply for a Provider Transaction Access Number (PTAN). PTAN application forms can be obtained by directly contacting the National Plan & Provider Enumeration System (NPPES) at (800) 465-3203. Applications can also be completed and submitted online through the NPPES website (see Resources).
Gather all information required to complete your PTAN application prior to completing the online application process. Once the application has been started you are unable to quit from the form or save any information entered on the application until you have completed the required forms.
Determine your health provide taxonomy code number. The taxonomy code is used to identify precisely what type of health care provider category that you are applying for. These codes are specialized according to group or individual provider, type of practitioner and subspecialty (see Resources.)
Create an National Provider Information (NPI) user ID. This ID will permanently connected with your PTAN information and cannot be changed once it has been entered. The ID cannot contain more than four digits.
Determine a password for your NPI account. The password should consist of 8 to 12 characters that contains at least one character and one number. The user ID and password cannot be the same. The system will not accept any special characters in the user ID or password
Submit five secret questions and answers to be entered into the NPI system. This information will be used to retrieve necessary log-on information in case it has been forgotten. Choose questions you are likely to remember for a long period of time, these questions and answers will be permanently tied to your NPI user ID.
Complete the necessary medical provider application forms to obtain a PTAN Medicare number. The NPI system and PTAN number is only for the use of health care providers. Use the information on your prepared lists to fill in details on the application. This application is relatively straightforward and should only take around 20 minutes to complete.
Double check the information you entered on your PTAN application for accuracy. Inaccurate information will lead to delays in receiving your PTAN number.
Wait for Medicare to review the credentials and information that you have submitted. PTAN numbers will not be issued until all credentials are correct and currently up to date.
Receive your new PTAN identifier from Medicare and start a billing relationship with Medicare insurance and Medicare patients.
The PIN and PTAN information is to be used only by physicians and other health care providers. It is not used for billing of Medicare patients to their physician.
Find your Medicare legacy provider number, which is also known as PIN. As of 2009, this PIN number will now be referred to as a provider access transaction number or PTAN. The physician and provider function for this reference number has not changed. It is a change in name only and will continue to be used in the same manner as the previous PIN number. Physicians with existing PIN numbers do not need to reapply for a PTAN number.
Use the correct PIN or PTAN number as a registered medical provider to avoid delays or rejection in Medicare billings for your office. The National Plan and Provider Enumeration System (NPPES) must have the correct PIN or PTAN identifier denoted in the "Other Provider Identifier" or "Other Provider Identifier Type Code" fields. This number must be correctly entered for billing purposes to identify the medical provider who provided a health care service to a Medicare patient. If this number is incorrect provider reimbursement may be delayed or rejected.
Once you begin the online application process, you will not be able to quit or save your work until the application has been completed.
Physicians and other providers must use the correct PIN or PTAN number to be be reimbursed for their Medicare-related services.
Deb Katula has written and researched for Societe Generale, FIMAT, Nikko Securities, Chicago Mercantile Exchange and Arthur Anderson. She holds an MBA in economics and finance from the University of Chicago; a Japanese language fellowship from Harvard; and a Bachelor of Arts in business/psychology/Asian studies from Augustana College.