A lot of information goes into preparing, submitting, and following up on claims. NPI and PTAN codes offer yet another illustration of why medical billing is so complex. The tricky part is choosing the right PTAN code when you are not exactly sure which one to use. Online access makes obtaining provider information fast and seamless. Otherwise, reimbursement delays are inevitable.įortunately, medical billing specialists have access to NPI and PTAN numbers online. In order to bill correctly, billing specialists need to have information about their respective providers. We explain all of this as a way of making it clear that NPI numbers are an important aspect of medical billing. Thus, the NPI number is more or less a universal identifier. Those standards must be maintained even when Medicare is not involved. The NPI system was developed to comply with HIPAA administrative standards. On the other hand, the NPI number is a universal number that is used to identify providers even outside of the Medicare system. What does that mean? It means the numbers are only utilized by CMS to verify providers in their system. PTAN Is Medicare SpecificĪnother difference worth mentioning is that PTAN numbers are Medicare-specific. So if one of the providers you bill for is associated with five different qualifying organizations, that provider will have five different PTAN numbers. In terms of having multiple numbers, Medicare issues a PTAN for every MAC contractor, practice, and healthcare group a provider is affiliated with. A provider would need to enter the PTAN number to gain access to online application status, the MAC portal, and so forth. But when a provider utilizes tools made available by a local Medicare administrative contractor (MAC), the additional PTAN number is required. Medicare only requires the NPI number on claim submissions. When it comes to PTAN numbers, that is a different story. Note that a provider will ever have only one NPI number. You can utilize NPI lookup to find practice names, organization names, practice specialties, addresses, and a limited amount of contact information. The NPI number is a unique 10-digit code you can look up to discover information about the medical providers you bill for. Do you know what those purposes are? Do you know the differences between the two types of numbers? One NPI Number Per Providerįederal laws require that all medical providers have a single and unique NPI number to be utilized for all transactions between providers, Medicare, and third parties. Though both NPI and PTAN numbers are used to verify providers, they do have differing purposes. If a provider tries to bill with an invalid number, there will be problems. So when you use our website to perform NPI lookup, you're looking for providers that have already been registered by the Centers for Medicare and Medicaid Services (CMS). Enter National Provider Identifier (NPI) and Provider Transaction Access (PTAN) numbers.īoth numbers are utilized by Medicare to verify providers. With that much money going back and forth, fraud is always a concern. In 2021 alone, Medicare spent nearly $840 billion covering subscriber medical bills. Medicare covers just over 18% of the U.S. News - industry news & Find-A-Code updates.Marketplace - recommended products & services.Library - buy digital books from Find-A-Code.Bookstore - buy physical books & cheat sheets.Subjects - Audits, E&M, HIPAA, Practice Mgt, etc.Specialties - Cardiology, ENT, Family Practice, etc.Payers - Medicare, Medicaid, BC/BS, Aetna, etc.Facilities & Organizations - ACOs, Hospitals, etc.For current years, an NPI will typically be associated with a single HCID. The HCID (from the HCIdea data) was historically used to assign the CCW-assigned prescriber identifier (CCW_PRSCRBR_ID). Using these input files, it is generally possible to identify a unique provider using an NPI, DEA number, and/or UPIN number. HCIdea has prescriber information from a variety of data sources, including the NPPES directory (the National Plan and Provider Enumeration System, which assigns a unique NPI to each provider), the Drug Enforcement Administration (through data files known as the Controlled Substances Act Registrants), and SureScripts (a nationwide e-prescribing network). Prior to 2014 data, the proprietary HCIdea™ Prescriber Database was used to uniquely identify prescribers since a variety of identifiers were allowed on the PDE. Prior to 2014 data, the NPI on the Prescription Drug Event (PDE) file was not allowed to be released, in accordance with CMS privacy rules. The CCW_PRSCRBR_ID was retired after 2013. This variable was new in 2014 beginning with 2014 Part D Prescriber Characteristics File, the NPI is used in place of the CCW_PRSCRBR_ID.
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