The Medicare-issued provider transaction access number (PTAN) is a six-digit authentication number that every healthcare service provider needs when enrolling with Medicare. However, patients should not have this number.
The Medicare provider transaction access number will be assigned based on the provider’s location and type of service offered. The first two digits will indicate the billing address or state of the healthcare service provider. The remaining digits will specify what kind of healthcare facility it is. That may include a long-term or short-term facility, a skilled nursing facility or a general hospital.
It’s also referred to as Medicare PIN, and sometimes people mispronounce or misspell it as “Medicare p10 number” or “p tan number.”
PTAN is different from the National Provider Identifier (NPI) number. The latter is a unique identification number mandated under the Health Insurance Portability and Accountability Act (HIPPA). All covered health care service providers, including health care clearinghouses and healthcare plans, must use the NPI number to engage in financial and administrative transactions that fall under HIPPA.
Why Is the PTAN Important?
Medicare fraud is quite rampant. Research shows that Medicare has an improper payment rate of about 15 percent, worth tens of billions of dollars.
When service providers use Medicare Administrative Contractor’s (MAC) self-help tools, the PTAN comes in handy. And together with the NPI number, it helps track medical billings. Medicare will keep a record of both numbers within their Provider Enrollment Chain & Ownership System (PECOS) concerning the provider who partners with them.
For this reason, the PTAN number is crucial in safeguarding against fraud because it helps authenticate the healthcare service providers who will receive payments.
It’s worth noting, though, that while the NPI number remains constant for a healthcare provider, the PTAN number will vary depending on the healthcare service provider one is connected with.
Applying For a Medicare PTAN
Below are tips on applying for Medicare PTAN.
1. Apply for the NPI Number
Since you also need your NPI number, you should start by applying for it first. You can do that by going to the National Plan & Provider Enumeration System (NPPES) website, opening an account and applying for an NPI number by following the prompts and instructions.
Healthcare service providers can also apply for an NPI number via Electronic File Interchange (EFI), which is done by organizations that specialize in that kind of work.
The third option involves contacting the NPI Enumerator for a copy of the NPI application form. Alternatively, if you are a health provider, you can access the application form on the CMS website and fill in your details. Inquiries can be mailed to the NPI Enumerator’s address at:
7125 Ambassador Road Suite 100
Windsor Mill, MD 21244-2751
You can also contact the office by phone using the number: 800-465-3203. In addition, the number TTY 1-800-692-2326 is available too.
You can also use the email address: email@example.com to get the answers you seek. And be sure to watch out for a confirmation message from the same address. You will get your NPI number through it. If you cannot see the message, look at your spam or junk folder.
Once the NPI Enumerator staff members have your details, they will upload them onto the NPPES platform.
Do not forget to include your taxonomy code when applying for your NPI. It designates your classification and specialization and is necessary for the application process to be completed.
2. Gather all the Necessary Information
In addition to your NPI number, you need to have other details available so you can fill them in through whichever platform you apply to. Some of these details include your legal name or business name, your fax number and your business numbers. You may also need your practice address.
Other details you may need to have to include a credit card for the application fee payments. You may also need a Provider Identification Number (PIN). So, be sure to gather all the necessary information before applying for a Medicare provider transaction access number so that you can do everything in one go.
3. Apply for Your PTAN
You can access your PTAN in several different ways. Everything depends on whether the healthcare service provider you work for or with has already partnered with Medicare or not.
If you are a healthcare provider who wants to work with an existing organization enrolled with Medicare, all you need to do is find the PTAN in the internet-based PECOS.
You can access your PECOS account and select My Associates>View Enrollments (next to the associated NPI number or TIN)> View Medicare ID Report. After that, you can view the PTAN number if your healthcare service provider is approved.
If your healthcare service provider doesn’t have a PTAN, then you can also enroll your organization from scratch through the PECOS platform and receive a new number that way.
The Medicare Provider Enrollment (PE) Department can also locate your PTAN if you ask for it in writing. Your letter should be on the provider’s letterhead and must include your NPI and signature. You can only request the number on your behalf if you want an individual PTAN. And if you want a group PTAN, you must be authorized to make that request.
Another option is to contact the Medicare Administrative Contractor (MAC) with a written and signed request on your company letterhead and ask for a PTAN. They will then process your application for you. If you already enrolled in Medicare via your MAC, then reference the notification letter your MAC sends you. But ensure you find the correct MAC for your location.
The National Plan and Provider Enumeration System (NPPES) also provides you with a way to obtain your PTAN. When doing your NPI number search, you can see your Medicare PTAN at the bottom of the National Provider Identifier (NPI) detail screen.
You cannot conduct business with Medicare without a PTAN, even if you have an NPI. For that reason, it would be wise to apply for it or locate your existing number as soon as possible.
To ensure a smooth application process, gather all your details beforehand and use valid credentials because you may not be able to quit or save your work to look for them. And once the number is given to you, you can begin billing Medicare. Also, remember that if you don’t bill Medicare for four consecutive quarters, your number will be deactivated.
- Plianced: WHAT IS A PTAN NUMBER?
- CMS.Gov: National Provider Identifier Standard (NPI)
- CMS.Gov: 2020 Estimated Improper Payment Rates for Centers for Medicare & Medicaid Services (CMS) Programs
- CIPROMS: NPI and PTAN: What’s the Difference?
- NPPES: Create a New Account
- CMS.Gov: EFI
- CMS.Gov: Announcing the Revised CMS-10114 National Provider Identifier (NPI) Application/Update Form
- CMS.Gov: NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FORM
- CMS.Gov: Find Your Taxonomy Code
- PECOS.CMS: Medicare Enrollment for Providers and Suppliers
- EUS.Custhelp: How to find a Medicare ID Number in PECOS
- WPSGHA: Locating a Provider Transaction Access Number (PTAN)
- Verisys: What Is a PTAN Number?
- CMS.Gov: Medicare Fee-for-Service Provider Enrollment Contact List
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