What is the Difference Between NPI and PTAN Numbers?

The Centers for Medicare & Medicaid Services (CMS) recently updated its MLN Matters SE1216 which examines the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN).

According to CMS, the NPI is different from a PTAN in the following ways:

  • A provider’s NPI is issued by the National Plan and Provider Enumeration System, which was developed by CMS to comply with the HIPAA Administrative simplification provisions for standard transactions. It is used by all health plans and health care clearinghouses when submitting HIPAA standard transactions.  A PTAN, on the other hand, is specific to Medicare and is issued to providers upon enrollment in Medicare.  Thus, to participate in Medicare, a provider needs both an NPI and a PTAN.
  • While a provider has only one NPI, the provider may have multiple PTAN numbers, representing enrollment through multiple practices or with multiple Medicare contractors.

The PTAN is necessary for authenticating the provider when the provider calls the Medicare Administrative Contractor (MAC) for information, whether through the customer service phone system or through the Interactive Voice Response (IVR) phone system.  The PTAN may also be required to authenticate the provider when using other self-help tools such as the internet portal.

A provider can find his or her PTAN by viewing the letter sent by the MAC approving the provider’s Medicare enrollment.  The PTAN can also be located by logging into the internet based Provider Enrollment Chain & Ownership System (PECOS), locating the applicable enrollment and clicking the “View Medicare ID Report” link.  The MLN Matters article also states that a provider can request a copy of his or her PTAN by sending a signed written request on company letterhead to the provider’s MAC.  The request must contain the provider’s legal name/business name, NPI, telephone and fax number.

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