Tuesday, April 9, 2013

NPI (National Provider Identifier) and the relationship to the PTAN (Provider Transaction Access Number)

I rec'd this info from a work associate this week, it is GREAT information regarding the NPI number and the PTAN...  

National Provider Identifier (NPI)

The NPI is a national standard under the Health Insurance Portability and
Accountability Act (HIPAA) Administrative Simplification provisions.

• The NPI is a unique identification number for covered health care

• The NPI is issued by the National Plan and Provider Enumeration
System (NPPES).

• Covered health care providers and all health plans and health care
clearinghouses must use the NPI in the administrative and financial transactions
(for example, insurance claims) adopted under HIPAA.

• The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). The NPI does not carry information about healthcare providers, such as
the state in which they live or their medical specialty. This reduces the chances
of insurance fraud.

• Covered providers and suppliers must share their NPI with other suppliers and providers, health plans, clearinghouses, and any entity that may
need it for billing purposes.

As of May 23, 2008, Medicare has required that the NPI be used in place of all
legacy provider identifiers, including the Unique Physician Identification Number
(UPIN), as the unique identifier for all providers, and suppliers in HIPAA standard

You should note that individual health care providers (including physicians who
are sole proprietors) may obtain only one NPI for themselves (Entity Type 1

Incorporated individuals should obtain one NPI for themselves (Entity
Type 1 Individual) if they are health care providers and an additional NPI(s) for
their corporation(s) (Entity Type 2 Organization).

Organizations that render health care or furnish health care supplies may obtain NPIs (Entity Type 2 Organization) for their organizations and their subparts (if applicable).

For more information about the NPI, visit the NPPES website at https://
nppes.cms.hhs.gov/NPPES/Welcome.do on the CMS website.

Provider Transaction Access Number (PTAN)
A PTAN is a Medicare-only number issued to providers by Medicare contractors
upon enrollment to Medicare. When a Medicare contractor approves enrollment
and issues an approval letter, the letter will contain the PTAN assigned to the

• The approval letter will note that the NPI must be used to bill the
Medicare program and that the PTAN will be used to authenticate the provider
when using Medicare contractor self-help tools such as the Interactive Voice
Response (IVR) phone system, internet portal, on-line application status, etc..

• The PTAN's use should generally be limited to the provider’s contacts
with Medicare contractors.

Relationship of the NPI to the PTAN

The NPI and the PTAN are related to each other for Medicare purposes. A
provider must have one NPI and will have one, or more, PTAN(s) related to it
in the Medicare system, representing the provider’s enrollment. If the provider
has relationships with one or more medical groups or practices or with multiple
Medicare contractors, separate PTANS are generally assigned.

Together, the NPI and PTAN identify the provider, or supplier in the Medicare
program. CMS maintains both the NPI and PTAN in the Provider Enrollment
Chain & Ownership System (PECOS), the master provider and supplier
enrollment system.

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