NPI and P10 legacy medicare numbers

[healthcarehiring]

Hello everybody, perhaps this belongs in the NPI forum, but it is more of a general question so here goes...

I manage a large number of websites, including healthcarehiring.com, our flagship site, which posts millions of health sector jobs and has about 5.5 million records of contact information for medical and healthcare providers.

We recently re-designed the site, and re-gathered a lot of data.  We now publish the NPI database, updated monthly, and offer a cross-reference search by "legacy" codes including oscar, upin, medicaid and state license number.

We also have hospital, home health and nursing home databases.  Previously all of these offered a search by medicare number.

With our re-design, we replaced some data for the home health and nursing homes -- and now some of our users, medical billers, are saying "where did the old medicare search go?"

My understanding is that for over a year, all billing must include NPI numbers.

Here is the question:  Why do they still want to search by old numbers?

Make no mistake, I am going to replace the old data and re-instate the medicare number search, that's today's project, we listen to our users.

But, I am trying to understand the overall medical billing process to see how I can make this site the very best resource for everybody who uses it.

Thanks a bunch
Mike Clark
Coconut Island Software, Inc.
coconutisland.com
healthcarehiring.com

[Michele]

Even though Medicare has required the use of NPI only for over a year, the provider must still know their PTAN, or legacy number when making any contact with Medicare.  However, those numbers are private, so I'm confused as to how you can post them.  Medicare will not even give those numbers to the provider themselves if they call in and request it.  They must send a written request.

 

Michele

[healthcarehiring]

Thank you Michele

I am not 100% sure what PTAN is, however HHS does provide a medicare number for home health, nursing home and dialysis in downloadable databases.  Hospital medicare numbers are also available. 

The NPI database includes up to 50 separate "other identifiers" (upin, bluecross, medicaid, etc.) plus up to 15 "license" numbers per record.  I believe these may be entered at the discretion of the registrant.

The NPI database is public information under the Freedom of Information Act. http://www.cms.hhs.gov/NationalProvIdentStand/06a_DataDissemination.asp

The way I understand it, in the medicare claims submission process, if there are multiple claimants for a patient within the billing period, the claimants need to coordinate with each other.  Is this correct?  What info about the other claimants does medicare give you?

I know that billers use our site to locate other providers in this process -- I am trying to get a better handle on exactly what our users need.  Transcriptionists also use us, I think more to locate physicians in the course of their work.

Cheers
Mike

[PMRNC]

The PTAN is the Medicare Provider Transaction Access Number and Michele is right, it cannot be accessed via any online database, below is the MLM Article on this.


 http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm5597.pdf 

[healthcarehiring]

Thanks Linda

I am looking at the pdf file for HomeHealthCompare, available from http://www.medicare.gov/Download/DownloadDB.asp

ProviderNum: text(6)
Lists the numeric code used to identify the provider listed.

This must be some other medicare identifier, not the PTAN.

[Pay_My_Claims]

npi replaced legacy numbers

[Michele]

QUOTE:

"The way I understand it, in the medicare claims submission process, if there are multiple claimants for a patient within the billing period, the claimants need to coordinate with each other.  Is this correct?  What info about the other claimants does medicare give you?"

I'm not sure what you mean here.  You bill for your Medicare services, you don't need to 'coordinate' with any other providers who may have seen the patient around the same time period.  And I'm not sure what you mean by 'billing period'.    Sorry but I think I'm missing the question.

 

Michele

[healthcarehiring]

I am pretty ignorant in this regard.  What I have heard from some of our users is that if more than one provider has submitted a claim for a patient (hospital, nursing home, home care), medicare responds with the  numbers of the other providers, and the billing personnel have to lookup the other provider.  I have been assuming they had to contact them, since they user our site to locate contact information. 

Is this just inaccurate in your opinion?

I know that if we have a technical problem or programming error, our users contact us right away, they depend on the site for these lookups.

[Michele]

I have never heard of anything like this.  Maybe it is for some other form of billing or something, but it is certainly news to me.

Michele

[PMRNC]

if more than one provider has submitted a claim for a patient (hospital, nursing home, home care), medicare responds with the  numbers of the other providers, and the billing personnel have to lookup the other provider.  I have been assuming they had to contact them, since they user our site to locate contact information.

No. No carrier would distribute data back to a provider on other providers .