PTAN Number in Medical Billing: What It Is, How It Differs From the NPI, and Where You Use It
A PTAN (Provider Transaction Access Number) is the Medicare-only identification number a Medicare Administrative Contractor (MAC) assigns to a provider or supplier when it approves a Medicare enrollment. It proves the enrollment. The NPI identifies the provider, and only the NPI goes on the claim.
If you have ever been asked for your “Medicare number” on the phone with the MAC and gave the NPI, the number they wanted was the PTAN. This is a common mix-up.
Where you see it
| Place | How the PTAN is used |
|---|---|
| MAC enrollment approval letter | the letter that tells you the CMS-855 application was approved includes the PTAN and the effective date |
| PECOS | My Associates, View Enrollments, View Medicare ID Report; every PTAN tied to the NPI, by enrollment |
| CMS-855I and CMS-855B | labeled “Medicare Identification Number (PTAN) (if issued)” on the forms; blank for a first enrollment |
| MAC provider portal registration | Noridian’s portal, for example, asks for the group or billing NPI, the PTAN, the TIN, the EDI submitter ID and a recent check amount |
| MAC interactive voice response (IVR) | authentication is NPI, PTAN and the last five digits of the TIN before any claim or eligibility question |
| EDI enrollment | the PTAN and NPI pair identifies the billing entity being set up to send 837 claims and receive 835 remittances |
| Redetermination and reopening forms | the provider section asks for name, NPI, PTAN and tax ID |
| The claim itself | nowhere. Medicare says to leave 24I blank, not report 32b, and not generally report 33b |
PTAN, NPI and tax ID side by side
| PTAN | NPI | Tax ID (EIN or SSN) | |
|---|---|---|---|
| Issued by | your MAC, after enrollment approval | CMS through NPPES | IRS (EIN) or SSA (SSN) |
| Scope | Medicare only, one contractor | every payer, nationwide | tax reporting; box 25 on the CMS-1500 |
| How many | one per enrollment, location and contractor | one per person (Type 1) or organization (Type 2), for life | one per legal entity |
| On the claim | no | yes (24J, 33a, 17b, 32a) | yes (box 25) |
| Changes when | you enroll in a new group, location or jurisdiction, or are deactivated and reactivated | never | the entity changes |
The CMS-855I defines the PTAN as a generic term for any number other than the NPI that a practitioner uses to bill Medicare; older letters may call it the Medicare Supplier Number or Medicare Billing Number. For institutional providers paid under Part A, the equivalent number is the CMS Certification Number (CCN).
One per enrollment
The PTAN maps one to one with an approved enrollment record, not with a person. That gives a group several patterns:
- A physician with reassigned benefits has an individual PTAN linked to the group. If she reassigns to a second group, she gets a second individual PTAN linked to that group.
- A group has a group PTAN for its billing NPI. Noridian, for example, assigns additional group PTANs only when a new practice location falls in a different payment locality.
- A second MAC jurisdiction means a separate enrollment and a separate PTAN. A practice with centers in two states served by different MACs holds a PTAN with each.
- Deactivation ends the PTAN. Noridian deactivates PTANs that have not billed for four consecutive quarters, and CMS deactivates billing privileges when a revalidation is missed. Reactivation is a new application.
How you get one
CMS lists four steps to enroll: obtain an NPI from NPPES, submit the enrollment application (in PECOS, or on paper with the CMS-855I for a physician or non-physician practitioner and the CMS-855B for a group, clinic or other supplier organization), pay the application fee if one applies, and work with your MAC, which may ask for more information. Reassignment of benefits to a group is now reported on the CMS-855I; the separate CMS-855R has been discontinued. When the MAC approves, the PTAN arrives in the letter.
Changes must be reported in PECOS: a change of ownership, an adverse legal action or a change in practice location within 30 days, other changes within 90 days.
Every enrollment must be revalidated, generally every five years (every three for DMEPOS suppliers). CMS posts due dates on the Medicare Revalidation List about seven months in advance and the MAC mails a notice three to four months before, but you are responsible for tracking it. Missing it can put payments on hold or deactivate billing privileges, and Medicare does not pay for services furnished while deactivated.
Worked example
Dr. Osei joins Sample Radiation Oncology, PC on September 1. She already has a Type 1 NPI. The group submits her CMS-855I with reassignment to the group in PECOS on August 20. The MAC approves on October 10, assigns her individual PTAN, and the letter states the effective date.
Meanwhile she has been treating patients. Her first claim, 77427 billed at 240.00 (illustrative), was sent on September 9 with her Type 1 NPI in 24J and the group’s Type 2 NPI in 33a. It denied with CARC B7: the provider was not certified or eligible to be paid for that service on that date of service. Nothing was keyed wrong; the MAC simply had no enrollment record linking her to the group yet.
After the letter arrives, the biller checks the effective date against each held date of service and resubmits the claims that fall on or after it. The PTAN itself is never typed onto the resubmitted claim. It goes into the practice’s enrollment roster and is used the following week to add Dr. Osei to the portal and the IVR.
What to do
- Keep an enrollment roster. For each physician and each location: NPI, PTAN, MAC, effective date and revalidation due date. Most practices keep this in a spreadsheet; what matters is that it exists and one person is responsible for it.
- Hold, do not send. For a new physician, hold claims until the approval letter arrives, then release the ones on or after the effective date. Watch the payer’s filing limit while you hold; see timely filing.
- Denials to recognize: CARC B7 (not eligible to be paid on that date), CARC 185 (rendering provider not eligible to perform the service), and CARC 16 with RARC N290 (rendering provider identifier missing or invalid). All three are enrollment problems first and claim problems second.
- Do not put the PTAN on the claim. The shaded part of 24J and box 33b are for payer-assigned legacy IDs and taxonomy where a payer asks; Medicare asks for neither.
- In Iridium Suite the provider record is the one place for each physician’s NPI and payer enrollment identifiers, and the claim scrubber checks the NPIs that actually go on the claim.
Related terms
- NPI numbers: Type 1 vs Type 2
- Rendering provider vs billing provider
- Taxonomy codes
- CMS-1500 box by box
- Timely filing limits
Further reading: CMS: Become a Medicare provider or supplier; PECOS; CMS: Revalidations (renewing your enrollment); Noridian: Provider Transaction Access Number (PTAN).
Frequently asked
What is a PTAN number?
A Provider Transaction Access Number is the Medicare-only identification number a Medicare Administrative Contractor issues when it approves a provider's or supplier's enrollment. It arrives in the approval letter and is also listed in PECOS. It proves you are enrolled with that contractor; the NPI identifies who you are.
Is the PTAN the same as the NPI?
No. The NPI is a national 10-digit identifier from NPPES that goes on every claim for every payer. The PTAN is Medicare's own enrollment number, used only when you communicate with your MAC, for example to authenticate on the IVR or register for the provider portal. Only the NPI is submitted on the claim.
How many PTANs does a provider have?
One per Medicare enrollment. A physician can have an individual PTAN for each group they have reassigned benefits to, and a group can have separate PTANs for practice locations in different payment localities or in different MAC jurisdictions. The PECOS Medicare ID Report lists all of them.
Where do I find my PTAN?
On the enrollment approval letter from your MAC, or in PECOS: My Associates, then View Enrollments, then View Medicare ID Report. The PTAN appears in the Medicare ID column. You can also ask your MAC's provider enrollment line, which will authenticate you first.