What Is a PTAN Number?

Because Medicare’s expansive system can be susceptible to fraud, it’s critical to identify and authenticate providers. Using a combination of PTAN and NPI numbers in their respective places helps healthcare organizations stay in compliance and protect Medicare from fraud and abuse as these organizations, providers, and patients rely on Medicare participation for their healthcare needs.

To help you understand PTAN numbers, we’ve provided a guide to what a PTAN number means, how providers can locate their numbers, and how a PTAN number can be differentiated and used to fight system fraud.

What Is a Provider Transaction Access Number (PTAN)?

The Provider Transaction Access Number (PTAN) is a Medicare-issued number given to providers upon enrollment with Medicare. This number is usually six digits and is assigned based on the type of service and the location of the provider. Upon enrollment, Medicare Administrating Contracting (MAC) providers should receive their assigned PTAN number in their approval letter.

The first two digits in the assigned code indicate the state of the provider or the state of the provider’s main billing address. For example, New York’s state code begins with 33 and Connecticut’s state code begins with 07. The CMS State Operations Manual provides the full list of codes according to states.

The remaining four digits of the PTAN number, described as a “series,” indicate the type of facility, or whether it is a short-term facility, general hospital, or a skilled nursing facility. If a letter is included in the series, the facility is either a specialty short-term facility or a general hospital.

What Is the Difference Between NPI and PTAN Numbers?

According to the Department of Health and Human Services (HHS), the NPI is a national standard under the Health Insurance Portability And Accountability Act (HIPAA). The provider’s NPI is a unique identification number issued by the National Plan and Provider Enumeration System (NPPES), which is used by all health plans and health care clearinghouses when submitting HIPAA standards transactions.

The NPI is a 10-digit number that does not include information about the provider. The NPI is intended as an identification number to share with other suppliers and providers, health plans, clearinghouses, and any entity that may need it for billing purposes.

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 number. While a provider has only one NPI, the provider may have multiple PTAN numbers, representing enrollment through multiple practices or with multiple Medicare contractors.

An approved provider should use the NPI to bill the Medicare program and the PTAN to authenticate the provider when using MAC self-help tools. With the NPI and PTAN numbers, the provider or supplier in the Medicare program can be easily identified and transactions can be tracked.

What Is the Relationship Between a PTAN Number and an NPI Number? 

Both numbers are maintained by CMS and are required to participate in Medicare. However, a provider’s NPI number is a single unique identifier issued by CMS’s National Plan and Provider Enumeration System to comply with HIPAA Administrative Simplification provisions. PTAN, in contrast, is Medicare-specific. While a provider will only have one NPI, they may have multiple PTAN(s). A provider may have multiple PTAN numbers if the provider is affiliated with multiple medical groups, practices, or medical contractors.

Locating Your PTAN Number

Here are three ways you can find your PTAN number:

1. Reference the notification letter sent by your MAC when your enrollment in Medicare was approved.
2. Log in to the PECOS online portal. Click on the “My Enrollments” button, then “View Enrollments.” Locate the applicable enrollment and click on the “View Medicare ID Report” link. This will list all of PTANs active providers and suppliers. If approved, your healthcare provider or supplier will be on the list.
3. Send a signed, written request on company letterhead to your MAC. Include your legal name or legal business name, national provider identifier (NPI), telephone, and fax numbers.

Why Is My PTAN Number Important?

Although the paperwork necessary for obtaining a PTAN number can seem overwhelming or confusing for healthcare entities, tracking Medicare providers and suppliers through PTAN numbers helps organizations in the long term by protecting them from unscrupulous providers. For administrators navigating the monitoring and compliance paperwork involved, there are many resources to guide them through these processes.

With the most trusted database of anti-fraud provider exclusion data, Verisys is here to help. To help you stay in compliance with state and federal program requirements, we can assist your organization with provider exclusion screening, license verification, credentialing, and continuous monitoring. Contact us today.

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