Medicare Compliance & Reimbursement

Critical: Ensure your PTAN hasn’t been deactivated due to inactivity.

If your Medicare Part B claims keep getting rejected due to too many Provider Transaction Access Numbers (PTANs) being attached to one National Provider Identifier (NPI), you may need to check your billing records and enrollment.

According to one Medicare Administrative Contractor (MAC), providers continue to have claims denied for PTAN/NPI incompatibility. “Medicare requires claims to contain NPIs to be accepted for adjudication,” explains Part B MAC First Coast Service Options (FCSO) in a release. “NPIs reported on the claims are cross walked to the Medicare assigned PTAN. Adjudication is based on a one-to-one relationship between the two.”

FCSO adds, “When a unique match cannot be made using the cross walk, claim development or rejections may occur.”

Pocket This PTAN Insight

The MACs issue PTANs at the onset of provider enrollment, and they are used for Medicare transactions only. Here’s where it gets tricky — only the NPI is submitted on claims; however, the PTAN, which is directly linked to the NPI, is used for communication between the MAC and the provider.

Additionally, a provider might have more than one PTAN if they have multiple practice locations. In that case, the MAC determines the charge locality and issues any additional PTANs.

A clinician could also be ineligible to receive a PTAN, in which case they’d need the beneficiary to submit form CMS-1490S, according to CMS guidance.

Deactivation happens quite frequently, too, says Part B MAC Noridian Healthcare Solutions. “Medicare is mandated by CMS to deactivate PTANs not being used. The deactivation process occurs every month.”

“A provider’s PTAN is deactivated when he or she has not billed the Medicare program for four consecutive quarters. A PTAN is given an end-date when it is deactivated, meaning claims can get submitted prior to the end-date within a year of the service date,” Noridian notes in online guidance.

Tip: Mapping the route and connecting the identification dots via the NPI/PTAN crosswalk can help providers get the numbers straight, FCSO suggests. “Our Claims Processing unit recommends using a one-to-one match if your enrollment allows for it,” the Part B MAC advises. “We understand certain enrollment situations may require more than one NPI. If your enrollment allows the use of one single NPI to one PTAN, this may prevent the need for us to develop for claim matching or possible claim rejections.”

Bottom line: Check with your Medicare carrier for the most accurate jurisdictional advice. If you’re confused about which MAC to contact over PTAN and NPI issues, review this contact information from CMS at www.cms.gov/medicare/provider-enrollment-and-certification/medicareprovidersupenroll/downloads/contact_list.pdf.