Do You Know The Difference Between NPI and PTAN Numbers

October 24th, 2022 - Find-A-Code
Categories:   Practice Management  

Medicare covers just over 18% of the U.S. population. In 2021 alone, Medicare spent nearly $840 billion covering subscriber medical bills. With that much money going back and forth, fraud is always a concern. Enter National Provider Identifier (NPI) and Provider Transaction Access (PTAN) numbers.

Both numbers are utilized by Medicare to verify providers. So when you use our website to perform NPI lookup, you're looking for providers that have already been registered by the Centers for Medicare and Medicaid Services (CMS). If a provider tries to bill with an invalid number, there will be problems.

Though both NPI and PTAN numbers are used to verify providers, they do have differing purposes. Do you know what those purposes are? Do you know the differences between the two types of numbers?

One NPI Number Per Provider

Federal laws require that all medical providers have a single and unique NPI number to be utilized for all transactions between providers, Medicare, and third parties. The NPI number is a unique 10-digit code you can look up to discover information about the medical providers you bill for.

You can utilize NPI lookup to find practice names, organization names, practice specialties, addresses, and a limited amount of contact information. Note that a provider will ever have only one NPI number. When it comes to PTAN numbers, that is a different story.

Multiple PTAN Numbers Per Provider

Medicare only requires the NPI number on claim submissions. But when a provider utilizes tools made available by a local Medicare administrative contractor (MAC), the additional PTAN number is required. A provider would need to enter the PTAN number to gain access to online application status, the MAC portal, and so forth.

In terms of having multiple numbers, Medicare issues a PTAN for every MAC contractor, practice, and healthcare group a provider is affiliated with. So if one of the providers you bill for is associated with five different qualifying organizations, that provider will have five different PTAN numbers.

PTAN Is Medicare Specific

Another difference worth mentioning is that PTAN numbers are Medicare-specific. What does that mean? It means the numbers are only utilized by CMS to verify providers in their system. On the other hand, the NPI number is a universal number that is used to identify providers even outside of the Medicare system.

The NPI system was developed to comply with HIPAA administrative standards. Those standards must be maintained even when Medicare is not involved. Thus, the NPI number is more or less a universal identifier.

An Important Part of Medical Billing

We explain all of this as a way of making it clear that NPI numbers are an important aspect of medical billing. In order to bill correctly, billing specialists need to have information about their respective providers. That information needs to be accurate. Otherwise, reimbursement delays are inevitable.

Fortunately, medical billing specialists have access to NPI and PTAN numbers online. Our NPI lookup tool is but one example. Online access makes obtaining provider information fast and seamless. It is as easy as looking up ICD codes. The tricky part is choosing the right PTAN code when you are not exactly sure which one to use.

NPI and PTAN codes offer yet another illustration of why medical billing is so complex. A lot of information goes into preparing, submitting, and following up on claims. It is all driven by data based on tens of thousands of codes that medical billing deals with on a daily basis. Will the system ever get simpler? Don't bank on it. If anything, it will only get more complicated.


Questions, comments?

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