Help Us to Help You: Have Your Provider and Patient Information Ready When You Call Customer Service

Published 01/14/2021

Having the required provider and beneficiary authentication elements available when you call Customer Service will save you time and help us handle your inquiry more efficiently.  

You will be asked for the following information about the provider:

  • The provider's National Provider Identifier (NPI)
  • The provider's Railroad Medicare Provider Transaction Access Number (PTAN)
  • The provider's Tax Identification Number (TIN): last five digits

The Centers for Medicare & Medicaid Services (CMS) requires authentication of these provider elements whenever a request would involve the disclosure of personally-identifiable information (PII) or protected health information (PHI). If you are not able to provide the required elements, our Customer Service Advocates may ask you to obtain the information and call back.

Don’t have your Railroad Medicare PTAN? Providers can use our PTAN Lookup and Request Tool to lookup their Railroad Medicare PTAN. If you are employed by a clearinghouse or third-party biller, you must contact the provider to obtain the Railroad Medicare PTAN. See our Using Railroad Medicare's Online PTAN Lookup and Request Tool article for details.

You will be asked to provide the following information about the beneficiary:

  • The beneficiary's Medicare Beneficiary Identifier (MBI)
  • The beneficiary's last name
  • The beneficiary’s first name or initial, and either
  • The claim date(s) of service (for post-claim inquiries, such as reason for denial or rejection) or 
  • The beneficiary's date or birth (for pre-claim inquiries, such as entitlement requests/issues)

The CMS requires authentication of these beneficiary elements prior to disclosing PII or PHI about a Medicare beneficiary to an authenticated provider. All information must match. If you are not able to provide the required elements, our Customer Service Advocates may ask you to obtain the information and call back. 

Don’t have the patient’s MBI?  There are three ways you and your office staff can get MBIs:

1. Ask your patient

2. Use the MBI Look-up tool on the Palmetto GBA eServices portal or your local Medicare Administrative Contractor’s portal

  • You can look up MBIs for your Medicare patients when they don’t or can’t give them. You must have your patient’s first name, last name, date of birth and Social Security Number (SSN) to search. If a patient doesn’t want to release their SSN to you, the patient will need to provide you with their MBI.  
3. Check a remittance advice
  • If you previously saw a patient and got a claim payment decision based on a claim submission with a HICN before January 1, 2020, look at that remittance advice. We returned the MBI on every remittance advice when a provider submitted a claim with a valid and active HICN from October 1, 2018 through December 31, 2019.
Resource: MLN SE18006 (PDF, 212 KB) — New Medicare Beneficiary Identifier (MBI) Get It, Use It

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