PTAN Help!

[Christy]

I am setting up a group of 2 chiropractors for Medicare EDI. I need their PTAN #. What is the format of the PTAN #?

I recently set up a LCSW and her PTAN was in the format of: A123456789.

the chiros are not providing me any Medicare IDs in that format. Are there other formats?


Also - it's 2 providers in one group. Is there a single group PTAN or do providers usually have individual?  they bill under the group.

thanks!

[DMK]

The PTAN is USUALLY the license number for chiropractors.  In California (for example) it's DC1234567.  On the phone you have to enter the letters as a * plus the 2 digits that represent the letter.  They have an explanation on the CMS site.

I do believe that each doctor has their own PTAN, and their enrollment in Medicare would have the group information on the application.  The group would have an NPI to bill under.

I'm fairly certain that Medicare assigns the PTANs.

[RichardP]

This is a slight expansion on what DMK says.  For established providers, the PTAN is the old PIN, or Provider Identification Number, from Medicare.  It takes the form of G12345, or AB12345, or WC1234B (the letters can be different, but those are the various formats).  Groups must have PTANs, and individual providers are supposed to have them as well.  A Group can only have one PTAN.  A provider needs a PTAN for each organization they work for.  So far as I know, PTANs are not used for billing.  They are used for I.D. purposes when trying to access any Medicare info pertaining to the billing.  The PTAN is tied to the registered address of the billing entity.  Since your guys bill under the Group, the billing would go in with the Group's address.  So any queries regarding that billing might require the Group's PTAN rather than the individual provider's PTAN.

In order for a provider to enroll into Medicare program, the provider must have a National Provider Identifier issued by the National Plan and Provider Enumeration System (NPPES). ... Once the NPI is issued the provider can complete a CMS 855 provider enrollment application and send it to Medicare Administrative Contractor’s (MAC) Provider Enrollment Department.  ...  The MAC’s Provider Enrollment department issues Medicare Providers a Medicare Transactions Number called the Provider Transaction Access Number (PTAN).

When [provider] enrolled in Medicare they sent a letter that showed completed enrollment and it also listed [provider's] PTAN number. If you need a new letter sent to the provider to obtain this number, you can call Medicare and request it be resent.

From here:

http://www.kmcuniversity.com/what-is-a-ptan-number/

[Christy]

thank you both!    very helpful!  I need it initially to enroll the group for EDI claims submission.... I am wondering it it will be one for each provider, or one for the group....sounds like one for the group...

ugh! I dislike Medicare for all their red tape!

[RichardP]

Just curious.  Have either of your chiro's applied to be Medicare providers and been accepted?  How about the Group?  If yes, the Provider I.D. numbers / PTAN will be found on those acceptance letters.

I direct your attention to the bolded sentence in my first post above.  I should have been more specific.  PTAN's are not used for billing.  But they are tied to the registered place-of-service address of the billing entity.  And they are also tied to the NPI number of the billing entity.  The billing you are talking about is being submitted by the Group - billing which is tied to its place-of-service address but also tied to the Group's NPI number in the billing info submitted.

A provider must have a PTAN for each place of service, but his PTAN is tied to his NPI Number as well.  The PTAN for a Group is also tied to its place-of-service address as well as to it's NPI Number.  If you call for information about a particular billing, you must provide a PTAN that is not only tied to that place-of-service address, but also to the NPI Number submitted with the billing.

Whose NPI number gets submitted with the billing you are talking about?  It would be the Group's, right (at least it should be if it is a Group as defined by Medicare).  So which PTAN would you need to provide if you call for information about that billing?  You need to provide the PTAN that is tied to both the place-of-service address and the NPI number that was submitted with the billing.  In this case, the only PTAN that matches this criteria is the PTAN of the Group.

I need it initially to enroll the group for EDI claims submission.

Who is submitting the billing?  The Group.  Whose place-of-service address and NPI number get included with that billing?  The Group.  Whose PTAN number must be used here?  The PTAN that matches the place-of-service and NPI number submitted with the billing.  In your case, it is that of the Group.  So the Group's PTAN is what is needed here.

All of that is an issue separate from the issue that you might need to provide identifying information for all owners of the group, or all employees who will be submitting billing under the Group's umbrella.  The Clearinghouse will tell you what information it needs for each of those.

[Christy]

thanks for the very thorough and helpful info, Richard!