Collapsing Medicare Provider Transaction Access Numbers (PTANs) to Ensure a One-to-One National Provider Identifier (NPI) Match
Provider Types Affected
Providers and suppliers billing Medicare contractors (Medicare Administrative Contractors (A/B MACs), and carriers) who provide services to Medicare beneficiaries are affected.
Provider Action Needed
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 5906 because it believes that providers and suppliers may want to collapse their assigned Medicare PTANs to ensure a one-to-one NPI match. Providers may collapse PTANs that are assigned to additional locations only if the additional locations are all assigned the same tax identification number (TIN) and are within the same pricing locality.
Please follow these steps to determine whether your locations are within the same pricing locality:
- Download Zip Code to Carrier Locality File spreadsheet
- On the spreadsheet, access the zip code for each of your locations
- Verify that the state in which your offices are located is the same state location you submitted when you went through the credentialing process with Palmetto GBA
- If your state location and credentialing information match, your locations are considered to be within the same pricing locality
Background
Changes in the Medicare provider and supplier enrollment process over the years have resulted in differences in the assignment of Medicare PTAN. Those differences, combined with Medicare's requirement to capture the NPI as part of the enrollment process, affect the type of information that is collected and maintained in Provider Enrollment, Chain Ownership System (PECOS), and then transferred to Medicare Claims System (MCS) and Medicare's NPI crosswalk.
Presently, some Medicare carriers issue separate PTANs to physicians, non-physician practitioners and other suppliers with multiple practice locations. To ensure that carriers are assigning PTANs in a more consistent manner and to aid in the implementation of the NPI, carriers and A/B MACs will assign the minimum number of PTANs necessary to ensure that proper payments are made.
Key Points
- Providers and suppliers can request their carrier or A/B MAC collapse their PTANs by submitting a letter on their letterhead to the Medicare contractor
- The letter must contain:
- The TIN of the provider/entity and/or the Social Security Number of the individual(s)
- The effective date for the collapsed PTANs
- A signature of the authorized official making the request
In addition, organizations must complete the following sections of the CMS 855B application:
- Section 1.A. - You are changing your information
- Section 1.B. - Practice Location Information
- Section 2.B.3. - Correspondence Address
- Section 3. - Adverse Legal Actions/Convictions
- Section 4 - should be replaced with a spreadsheet containing all the PTANs for the group and its individuals with associated NPIs, all practice location addresses for the group and any special payment address, and identify on the spreadsheet of which group/individual PTANS are to remain active and which are to be end dated
- Section 13. - Contact person
- Section 15 - Certification Statement
Sole Proprietors, in addition to the letter, must submit the following sections of the CMS 855I application:
- Section 1.A. - You are changing your information
- Section 1.B. - Practice Location Information
- Section 2.A. - Identifying information
- Section 2.B. - Correspondence Address
- Section 3. - Adverse Legal Actions/Convictions
- Section 4 - should be replaced with a spreadsheet containing all the PTANs for the sole proprietor with associated NPIs, all practice location addresses and any special payment address, and identify on the spreadsheet of which PTANS are to remain active and which are to be end dated
- Section 13. - Contact information
- Section 15 - Certification Statement
- If it is determined, the provider or supplier is not in PECOS, the Medicare contractor will request a complete 855B or 855I application to be submitted
- Internet-based PECOS which is to be implemented later this year will not support collapsing of assigned Medicare PTANs by a provider or supplier
Therefore, if a provider or supplier requests to collapse their Medicare PTANs, this process will have to be done by the CMS 855 paper application process.
Additional Information
To see the official instruction,
CR 5906 (PDF, 346 KB), issued to your Medicare Carrier or A/B MAC.
If you have questions, please contact our Provider Contact Center at our toll free number at (866) 332-7025 for Ohio and West Virginia or (888) 828-2092 for South Carolina.